Exstrophy of the bladder: Presentation and management in Soba University Hospital

Abstract

This is a retrospective review directed to describe the presentation of bladder exstrophy patients, their management and the outcome. The main data sources were patients' records and examination of out patients attending for follow up. In the period between June 1996 to June 2002, thirty-one patients were admitted and treated for bladder exstrophy. Twenty-three patients were males and 8 were females with sex ratio 3 : 1. Twenty-four patients (77%) were treated by internal urinary diversion (ureterosigmoidostomy). Seven patients (23%) were treated with primary reconstruction. The diversion group were operated on initially at a mean age of 7.2 ± 6.5 years, while the reconstruction group at a mean age of 6.6 ± 7.5 months. In the patients who underwent urinary diversion 11 (46%) patients were fairing well, 10(45%) patients suffered repeated U.T.I and hydronephrosis occurred in eight (38%) of the patients. There was no clinical evidence of acidosis. Twenty patients (91%) of the diversion group are continent during the daytime, however, two patients (9%) were totally incontinent. Revision of the initial diversion procedure was needed in four patients due to hydronephrosis. In two patients the renal function deteriorated and one died. Of the 7 patients who underwent primary reconstruction 6 patients (86%) had successful primary bladder closure, one patient had complete wound dehiscence in the early postoperative period. Four patients underwent bladder neck reconstruction, of these three patients (75%) were continent. One patient was totally incontinent and had severe U.T.I. In another patient the bladder was found to be unsuitable for BNR because of too small capacity. Epispadias repair was performed in three patients. Of these one patient developed hypospadias-like urethral defect and another developed urethral fistula. Both were waiting for reconstruction. We concluded that urinary diversion inspite of its salient defects will continue to be the best compromise for late presenting patients. Primary reconstruction suits early presenting patients who can afford repeated operations. We also emphasize the importance of increasing population awareness of the health risks of exstorophy surgery and the need for regular life long follow up. Patients' records should be improved to enable valid future evaluation.