Background: The need for bladder neck reconstruction (BNR) after complete primary repair of bladder exstrophy(CPRE) has not been determined. Furthermore, the effects of BNR on bladder growth and function after CPRE has not been previously described.
Methods: Patients who have undergone BNR after CPRE were evaluated with voiding cystourethrograms, radionuclide cystograms, renal ultrasound, and urodynamics (UDS). Parents were also questioned regarding urinary and fecal continence status. Bladder capacity was determined and percent predicted bladder capacity (PPBC) for age was calculated before and after BNR.
Results: From 1994 to 2007, CPRE was performed in 28 patients. Of these, 4 males have undergone BNR because of persistent urinary incontinence. Median age at BNR was 4.5 years (range 4-8). Median follow-up time for these patients is 7 years (range 5-10) and median follow up since BNR is 2 years. Renal scans were normal in 3 of 3 patients evaluated. Of 3 evaluable patients only one has continent intervals >3hrs. No patients exhibited detrusor overactivity during UDS. See figure 1 for PPBC versus age. The PPBC is no greater than 32% for any patient.
Conclusions: Our data suggests that urinary continence is inadequate after BNR. Although evaluation post BNR in our patients is short term, our findings suggest an intrinsic bladder abnormality that may impair the bladder's ability to respond to increased outlet resistance. With its need to sacrifice bladder tissue and capacity, standard BNR may not prove to be the optimal approach to improved continence in this population.