Bladder Exstrophy Closure without Osteotomy in Philadelphia

  • Douglas A. Canning
  • Thomas Lanchoney
  • Simone McKitty
  • Stephen Zderic
  • Howard M. SnyderIII
  • John W. DuckettJr.



To evaluate the complications following initial bladder closure and urinary continence in patients born with bladder exstrophy closed early without posterior iliac osteotomy.

Materials and Methods

A retrospective review of 105 patients treated at The Children’s Hospital of Philadelphia (CHOP) since 1952. Sixty-two patients had initial treatment at CHOP. Age at initial closure, surgical procedure and complications were noted. Follow up was performed with detailed questions regarding continence. Patients completing reconstructive surgery for continence were grouped as follows: Dryness was recorded as dry day and night, dry day only, dry three hours or wet. Continent patients were those patients who had achieved at least a 3-hour dry interval without the need for intermittent catheterization. Statistical analysis was performed using Fisher’s exact test.


Of 62 patients who had initial therapy at CHOP, 12 had initial ureterosigmoidostomy. Initial bladder closure was performed at CHOP for the remaining 50. Of the 50, 45 had both the closure and subsequent continence procedures at CHOP. Thirty-one of 43 (71%) of patients closed without osteotomy had a successful closure. Three of 5 closed with osteotomy were successful. Only 6 (13%) of the 45 patients are voiding through the native bladder with continence. Thirty (67%) of 45 are dry with intermittent catheterization. Neither age at initial closure, use of posterior iliac osteotomy nor use of paraexstrophy flaps (PEF) affected continence or complication rates of the initial bladder closure. Of only 5 patients closed with osteotomy, 2 are continent and voiding with the native bladder compared to only 4 of 20 patients closed without osteotomy (p=0.065).


Continence following staged reconstruction for bladder exstrophy is difficult to achieve even at a center with considerable experience. Most patients can be dry with intermittent catheterization or early closure of the bladder without osteotomy is not associated with increased risk of complications compared with closure with osteotomy. Despite few patients in this series, a trend toward improved continence in patients undergoing osteotomy was observed.


Bladder Neck Bladder Outlet Obstruction Intermittent Catheterization Urinary Continence Bladder Exstrophy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Gearhart, J.P., et al., The multiple reoperative bladder exstrophy closure: what affects the potential of the bladder? Urology, 1996. 47(2): p. 240–3.Google Scholar
  2. 2.
    Husmann, D.A., G.A. McLorie, and B.M. Churchill, Closure of the exstrophic bladder: an evaluation of the factors leading to its success and its importance on urinary continence. J Urol, 1989. 142(2 Pt 2 ): p. 522–4.Google Scholar
  3. 3.
    Lottmann, H.B., et al., Bladder exstrophy: evaluation of factors leading to continence with spontaneous voiding after staged reconstruction. Journal of Urology, 1997. 158(3 Pt 2): p. 1041–4.Google Scholar
  4. 4.
    Jeffs, R.D., Functional closure of bladder exstrophy. Birth Defects, 1977. 13 (5): p. 171–3.PubMedGoogle Scholar
  5. 5.
    Duckett, J.W., Use of paraexstrophy skin pedicle grafts for correction of exstrophy and epispadias repair. Birth Defects, 1977. 13 (5): p. 175–9.PubMedGoogle Scholar
  6. 6.
    Spindel, M.R., B.H. Winslow, and G.H. Jordan, The use ofparaexstrophy flaps for urethral construction in neonatal girls with classical exstrophy. J Urol, 1988. 140 (3): p. 574–6.PubMedGoogle Scholar
  7. 7.
    Gearhart, J.P., D.S. Peppas, and R.D. Jeffs, Complications of paraexstrophy skin flaps in the reconstruction of classical bladder exstrophy. Journal of Urology, 1993. 150 (2 Pt 2): p. 627–30.PubMedGoogle Scholar
  8. 8.
    Leadbetter, G.W.J., Surgical correction of total urinary incontinence. J. Urol., 1964. 7: p. 1–32.Google Scholar
  9. 9.
    Koff, S.A., A technique for bladder neck reconstruction in exstrophy: the cinch. J Urol, 1990. 144 (2 Pt 2): p. 546–9.PubMedGoogle Scholar
  10. 10.
    Mollard, P., P.D. Mouriquand, and X. Buttin, Urinary continence after reconstruction of classical bladder exstrophy (73 cases). Br J Urol, 1994. 73 (3): p. 298–302.PubMedCrossRefGoogle Scholar
  11. 11.
    Connor, J.P., et al., Long-term followup of 207 patients with bladder exstrophy: an evolution in treatment. J Urol, 1989. 142(3): p. 793–5.Google Scholar
  12. 12.
    de la Hunt, M.N. and B. O’Donnell, Current management of bladder exstrophy: a BAPS collective review from eight centres of 81 patients born between 1975 and 1985. J Pediatr Surg, 1989. 24 (6): p. 584–5.PubMedCrossRefGoogle Scholar
  13. 13.
    Canning, D.A., Bladder exstrophy: the case for primary bladder reconstruction [editorial]. Urology, 1996. 48 (6): p. 831–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Hohenfellner, R. and R. Stein, Primary urinary diversion in patients with bladder exstrophy [editorial]. Urology, 1996. 48 (6): p. 828–30.PubMedCrossRefGoogle Scholar
  15. 15.
    Canning, D., et al., A computerized review of exstrophy patients managed during the past thirteen years. J. Urol., 1989. 141: p. 224A.Google Scholar
  16. 16.
    Gearhart, J. and R. Jeffs, Exstrophy-Epispadias complex and bladder anomalies, in Campells Urology,P. Walsh, et al.,Editors. 1998, WB Saunders: Philadelphia. p. 1939–1990.Google Scholar
  17. 17.
    Ngan, J., et al., Factors contributing to urinary continence in classic exstrophy. J. Urol, 1996. 155(5): p. 483A.Google Scholar
  18. 18.
    Kelley, J., Vesical exstrophy: repair using radical mobilisation of soft tissues. Pediatric Surgery International, 1995. 10: p. 298–304.Google Scholar

Copyright information

© Springer Science+Business Media New York 1999

Authors and Affiliations

  • Douglas A. Canning
    • 1
  • Thomas Lanchoney
    • 1
  • Simone McKitty
    • 1
  • Stephen Zderic
    • 1
  • Howard M. SnyderIII
    • 1
  • John W. DuckettJr.
    • 1
  1. 1.The Children’s Hospital of PhiladelphiaPhiladelphiaUSA

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