Early outcome following complete primary repair of bladder exstrophy in the newborn

Joseph G. Borer, Patricio C. Gargollo, W. Hardy Hendren, David A. Diamond, Craig A. Peters, Anthony Atala, Rosemary Grant, Alan B. Retik, Joao L. Pippi-Salle, Alberto Lais, Ranjiv Mathews

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Purpose: Complete primary repair of bladder exstrophy (CPRE) represents a paradigm shift from the staged approach for surgical management. We present early clinical outcomes in our patients following CPRE. Materials and Methods: From 1996 to 2004 all newborns with bladder exstrophy were treated with CPRE within 48 hours of birth. We reviewed parameters including transfusions (packed red blood cells), urethral meatal position, complications, findings on renal ultrasound and renal scan, and post-CPRE procedures and infections. Results: A total of 16 boys and 7 girls were treated with CPRE. Followup ranged from 8 to 96 months. Twelve boys (75%) and 2 girls (29%) received packed red blood cells at CPRE (p = 0.066). The tubularized urethral plate could not be brought to the penile tip, resulting in hypospadias in 9 of 11 boys (82%) with the running suture technique and only 1 of 5 boys (20%) with the interrupted technique (p = 0.036). Of the 23 patients 6 had a total of 8 complications after CPRE. Vesicoureteral reflux was present in 17 of 23 patients. After CPRE a total of 93 endoscopic/ surgical procedures (median 4, range 0 to 16 per patient) were performed. Five patients had 1 to 4 episodes of pyelonephritis, 16 of 23 had 1 or more episodes of asymptomatic bacteriuria and 5 had cortical defects on renal scan. Conclusions: We recommend that urethral closure during CPRE be performed with interrupted suture technique to prevent hypospadias. An aggressive approach should be taken toward reflux in the setting of urinary infection. Consideration should be given for repair of all aspects of the defect during CPRE, including bilateral ureteral reimplantation.

Original languageEnglish
Pages (from-to)1674-1679
Number of pages6
JournalJournal of Urology
Volume174
Issue number4 II
DOIs
StatePublished - Oct 1 2005
Externally publishedYes

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Bladder Exstrophy
Newborn Infant
Suture Techniques
Hypospadias
Kidney
Erythrocyte Transfusion
Vesico-Ureteral Reflux
Bacteriuria
Replantation
Pyelonephritis
Infection
Endoscopy

Keywords

  • Bladder exstrophy
  • Complications
  • Surgery

ASJC Scopus subject areas

  • Urology

Cite this

Borer, J. G., Gargollo, P. C., Hendren, W. H., Diamond, D. A., Peters, C. A., Atala, A., ... Mathews, R. (2005). Early outcome following complete primary repair of bladder exstrophy in the newborn. Journal of Urology, 174(4 II), 1674-1679. https://doi.org/10.1097/01.ju.0000175942.27201.59

Early outcome following complete primary repair of bladder exstrophy in the newborn. / Borer, Joseph G.; Gargollo, Patricio C.; Hendren, W. Hardy; Diamond, David A.; Peters, Craig A.; Atala, Anthony; Grant, Rosemary; Retik, Alan B.; Pippi-Salle, Joao L.; Lais, Alberto; Mathews, Ranjiv.

In: Journal of Urology, Vol. 174, No. 4 II, 01.10.2005, p. 1674-1679.

Research output: Contribution to journalArticle

Borer, JG, Gargollo, PC, Hendren, WH, Diamond, DA, Peters, CA, Atala, A, Grant, R, Retik, AB, Pippi-Salle, JL, Lais, A & Mathews, R 2005, 'Early outcome following complete primary repair of bladder exstrophy in the newborn', Journal of Urology, vol. 174, no. 4 II, pp. 1674-1679. https://doi.org/10.1097/01.ju.0000175942.27201.59
Borer JG, Gargollo PC, Hendren WH, Diamond DA, Peters CA, Atala A et al. Early outcome following complete primary repair of bladder exstrophy in the newborn. Journal of Urology. 2005 Oct 1;174(4 II):1674-1679. https://doi.org/10.1097/01.ju.0000175942.27201.59
Borer, Joseph G. ; Gargollo, Patricio C. ; Hendren, W. Hardy ; Diamond, David A. ; Peters, Craig A. ; Atala, Anthony ; Grant, Rosemary ; Retik, Alan B. ; Pippi-Salle, Joao L. ; Lais, Alberto ; Mathews, Ranjiv. / Early outcome following complete primary repair of bladder exstrophy in the newborn. In: Journal of Urology. 2005 ; Vol. 174, No. 4 II. pp. 1674-1679.
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abstract = "Purpose: Complete primary repair of bladder exstrophy (CPRE) represents a paradigm shift from the staged approach for surgical management. We present early clinical outcomes in our patients following CPRE. Materials and Methods: From 1996 to 2004 all newborns with bladder exstrophy were treated with CPRE within 48 hours of birth. We reviewed parameters including transfusions (packed red blood cells), urethral meatal position, complications, findings on renal ultrasound and renal scan, and post-CPRE procedures and infections. Results: A total of 16 boys and 7 girls were treated with CPRE. Followup ranged from 8 to 96 months. Twelve boys (75{\%}) and 2 girls (29{\%}) received packed red blood cells at CPRE (p = 0.066). The tubularized urethral plate could not be brought to the penile tip, resulting in hypospadias in 9 of 11 boys (82{\%}) with the running suture technique and only 1 of 5 boys (20{\%}) with the interrupted technique (p = 0.036). Of the 23 patients 6 had a total of 8 complications after CPRE. Vesicoureteral reflux was present in 17 of 23 patients. After CPRE a total of 93 endoscopic/ surgical procedures (median 4, range 0 to 16 per patient) were performed. Five patients had 1 to 4 episodes of pyelonephritis, 16 of 23 had 1 or more episodes of asymptomatic bacteriuria and 5 had cortical defects on renal scan. Conclusions: We recommend that urethral closure during CPRE be performed with interrupted suture technique to prevent hypospadias. An aggressive approach should be taken toward reflux in the setting of urinary infection. Consideration should be given for repair of all aspects of the defect during CPRE, including bilateral ureteral reimplantation.",
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AU - Atala, Anthony

AU - Grant, Rosemary

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