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138
29
th
CONGRESS OF THE ESPU
S18: EXTROPHY-EPISPADIAS
COMPLEX 2
Moderators: Marc-David Leclair (France), Raimondo Maximilian Cervellione (UK)
ESPU Meeting on Friday 13, April 2018, 15:02–15:34
15:02–15:07
S18-1 (LO)
MANAGEMENT OF FAILED EXSTROPHY CLOSURE:
A 50 YEAR EXPERIENCE
Matthew KASPRENSKI, Karl BENZ, Mahir MARUF, John JAYMAN, Heather DI
CARLO and Johan GEARHART
Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Division of Pediatric Urology, James Buchanan Brady
Urological Institutions, Baltimore, USA
PURPOSE
This study investigates factors that contribute to a successful repeat bladder closure and explores
the effect of failed closures on continence status in patients with classic bladder exstrophy (CBE).
MATERIAL AND METHODS
The authors reviewed a prospectively maintained institutional database of 1311 exstrophy-epispa-
dias complex patients for CBE patients with a failed primary bladder closure from 1965–2017, who
have consequently undergone a repeat closure. Our primary objective was to determine factors
associated with successful repeat closure.
RESULTS
A total of 170 patients had at least one repeat closures following a failed primary closure (115 male/
55 female). The success rate was 126/170 (74.1 %) for all second closures, 29/42 (69.0 %) for
all third closures, 9/12 (75 %) for all fourth closures, and 2/3 (66.7 %) for all fifth closures. With
continued closure attempts, 166/170 (97.6 %) patients were successfully closed. Fifty (29.4 %)
osteotomies were performed during the 170 failed primary closures, while 128 (75.3 %) osteoto-
mies were done during the 170 second closures and 27 (64.3 %) osteotomies were done during
the 42 third closures. Seventy-four of ninety-six (77.1 %) patients achieved urinary continence.
Continence was achieved in thirteen of twenty-three (56.5 %) patients with a BNR alone, 12 of
14 (85.7 %) patients with BNR with augment and/or stoma, and 50 of 57 (87.7 %) patients with
a continent urinary diversion (p=0.010).
CONCLUSIONS
A successful repeat closure is possible in the majority of cases, especially when used in conjunction
with osteotomy. A combined anterior-posterior osteotomy approach was associated with the highest
success rate during repeat closure. Continent urinary diversion yielded the highest continence rate.