The Impact of Urodynamics on Surgery for Incontinence in Children with Exstrophy
The urologic management of the exstrophy patient has always been a daunting experience for clinicians. Following closure, these children often have continued to suffer from urinary incontinence. The decision to enlarge the bladder and/or increase urethral resistance has been a difficult choice for the urologic surgeon, based solely on clinical grounds and radiographic assessment. The ability to accurately predict which procedure singly or in combination would achieve continence has never been very high. In recent years urodynamic testing (UDS) has become an integral part of the preoperative evaluation of the exstrophy patient following closure, especially if incontinence remains an issue. The findings in children with intractable wetting treated at Children’s Hospital is presented to provide guidelines for managing this complex anomaly.