Our initial experience with the technique of complete primary repair for bladder exstrophy.

OBJECTIVE: We reviewed our initial results with complete primary repair of exstrophy in regard to continence status and the need for subsequent continence procedures.

PATIENTS AND METHODS: We performed a retrospective review of our surgical records from 1996 to 2008 to identify all patients with bladder exstrophy managed at our center.

RESULTS: Sixteen children were closed successfully. Six patients (37.5%) experienced complications: umbilical hernias in two, transient penopubic fistula in three, and subcoronal fistula due to meatal stenosis in one. Of the 12 males, seven (58.3%) were left with a hypospadias at the time of primary closure. Two (22.2%) children required a formal bladder neck reconstruction to achieve continence. Bladder augmentation and continent catheterizable stoma was performed in four cases (44.4%), and bladder neck injection in one case (11.1%). Bladder neck closure was also performed in another child following primary closure. Three of these children are continent and void spontaneously (33.3%). The remaining six require clean intermittent catheterization four to six times a day, resulting in four (44.4%) being continent. The number of continence procedures and mean number per patient were 15 and 1.66, respectively.

CONCLUSION: Our early experience with this technique has been encouraging, with few major complications, a highly successful closure rate and a cosmetically normal result.