Bladder Exstrophy for the General Urologist

Abstract

In this chapter, modern techniques for managing the newborn with classic bladder exstrophy are discussed. Management is based on the author’s experience and on data from more than 700 patients with the bladder exstrophy-epispadias-cloacal exstrophy spectrum seen at our institution. In addition, new basic science discoveries of interest to both the general and the pediatric urologist will be discussed. The primary objectives of modern surgical management of classic bladder exstrophy are as follows: (1) to create a secure abdominal closure, (2) to reconstruct a functional and cosmetically acceptable penis in the male and to reconstruct female external genitalia in the female, and (3) to preserve urinary continence, renal function, and volitional voiding. Currently, these objectives can best be achieved with newborn primary bladder and posterior urethral closure and early epispadias repair. Reconstruction of the bladder neck is undertaken when the bladder reaches an appropriate volume for an outlet procedure and the child is ready to participate in a postoperative voiding program. In this chapter, we will limit our discussion to the early management and initial primary closure of these infants.