Results of Epispadias Repair Using the Modified Cantwell-Ransley Technique.

OBJECTIVE: To evaluate our results of epispadias repair with a modified Cantwell-Ransley (MCR) technique. METHODS: A retrospective Institutional Review Board-approved chart review of all patients who underwent an MCR epispadias repair was conducted between 1998 and 2015. Procedures were performed at birth or after the age of 8 months as part of the modern staged repair of exstrophy-epispadias complex (EEC) in patients with bladder exstrophy treated since birth, at presentation for older patients, and after the age of 6 months in isolated epispadias patients. Twenty-two children underwent MCR epispadias repair in our institute during the study period. Sixteen of them had EEC and 6 had isolated epispadias. Four patients underwent exstrophy and epispadias repair at the same session. Twelve children underwent epispadias repair as a second stage of modern staged repair at a mean age of 21 months (range 8-60). The procedures involved dissection of the corporeal bodies and urethral plate from the penile base to the tip of the penile glans. RESULTS: After a mean follow-up of 6.9 years (range 0.5-18), there were no complications in the isolated epispadias group and 4 complications in the bladder exstrophy group: urethrocutaneous fistula (n = 1), residual dorsal curvature (n = 1), and excess of penile skin (n = 2). The meatal location was orthotopic in all cases. All of the complications were successfully addressed in a single subsequent surgical session. CONCLUSION: MCR technique continues to be a reliable, reproducible option for epispadias repair in EEC patients and in cases of isolated epispadias.

Can Classic Bladder Exstrophy be Safely and Successfully Reconstructed at a Low Volume Center?

PURPOSE: Exstrophy reconstruction is challenging and requires expertise and experience. However, many patients are treated at low volume centers. We evaluated whether classic bladder exstrophy could be safely and successfully reconstructed at a low volume center. MATERIALS AND METHODS: A total of 31 patients with classic bladder exstrophy were primarily treated at our low volume center during a 17-year period. A total of 22 patients underwent primary closure within 5 days of birth and 9 underwent delayed closure with osteotomy. Of the patients 29 underwent planned modern staged repair and 2 underwent attempted complete primary repair. RESULTS: The bladder was successfully closed in all 31 children. All 22 newborns underwent primary bladder closure without osteotomy, including 4 with extremely small bladder plates. Bladder neck obstruction developed in 3 patients (10%), of whom 2 were treated successfully with transurethral dilation and 1 underwent open repair. Epispadias repair was successful in 12 of 15 patients undergoing the Cantwell-Ransley technique and in 2 of 4 undergoing complete primary repair. A total of 16 patients underwent bladder neck reconstruction, of whom 9 are awaiting appropriate age or capacity, 4 were lost to followup, 1 is continent after bladder closure alone and 2 underwent continent diversion (1 after failed bladder neck reconstruction). Of the 15 patients with at least 1 year of followup after bladder neck reconstruction 9 are continent day and night, 2 are continent only during the daytime and 4 are incontinent, for a 73% post-bladder neck reconstruction continence rate (11 of 15 patients). CONCLUSIONS: Successful exstrophy reconstruction is achievable at a low volume center, with results comparable to those of high volume centers.

A combined vertical and horizontal pelvic osteotomy approach for repair of bladder exstrophy: the Dana experience.

BACKGROUND: Bladder exstrophy is a severe congenital defect that requires a multidisciplinary treatment approach. Soft tissue repair may be successful during the first few days after birth, but a combination of pelvic osteotomies and bladder reconstruction is necessary later in life. The combination of externally fixed anterior and posterior osteotomies has biomechanical advantages over previous techniques for achieving primary bladder closure. OBJECTIVES: To describe our experience with a combined vertical and horizontal pelvic osteotomy approach for the repair of bladder exstrophy. METHODS: Four children underwent bladder exstrophy closure; the mean age at surgery was 19 months (range 9-33 months)... We stabilized the osteotomies with a small Synthes AO external fixator, 4.0 mm rod diameter. RESULTS: All four patients had successful bladder repair with no dehiscence; two of them achieved partial continence, and bladder neck reconstruction is planned for the other two. Three of the four patients sustained neurologic injury; two completely recovered, and the third continues to suffer from right drop foot. The average follow-up was 39 months (range 10-60 months). CONCLUSIONS: Vertical and horizontal pelvic osteotomies stabilized by external fixator and bladder repair is an effective treatment for bladder exstrophy.