V07-05: Complete Primary Repair of Bladder Exstrophy in the Girl: Risk Factors for Urinary Retention Lessons Learned and Current Technique
Following recent technical modifications, we observed urinary retention in some girls post-complete primary repair of bladder exstrophy (CPRE). Our aim herein was to provide video representation of modifications incorporated into current CPRE technique for girls with bladder exstrophy (BE), following identification of potential contributing factors responsible for this observation.
Girls with BE that underwent CPRE from December 1998 through September 2016 at our institution were reviewed with IRB approval. We recorded operative age, anatomic dimensions, use of osteotomy, pelvic immobilization, clinical course and additional surgeries. Patients were deemed in urinary retention if their clinical course was applicable and required a procedure(s) and/or clean intermittent catheterization (CIC) to relieve retention.
Nineteen girls underwent CPRE. In 2012, a change to performing CPRE at approximately 6-8 weeks of age was made. This led us to divide our experience into CPRE performed as a newborn (<72 hours of age) versus delayed (>72 hours) groups. Eight (42%) had newborn and eleven (58%) delayed CPRE (Table). There were no girls with retention in the newborn group. In the delayed group 3 experienced retention; 1 girl required repair of bladder rupture and CIC, 1 CIC only, and 1 endoscopic bladder neck (BN) incision. In the delayed group, girls had a significantly longer urethral plate and narrower BN compared to the newborn group. Long-term outcomes >9 years were available in 6 girls in the newborn group and 2 (33%) required BN procedures for incontinence. None in the delayed group have required incontinence procedures with limited follow up.
The increased risk of urinary retention in our delayed group may have been secondary to technical revision of CPRE (elongation of the urethra and the dissection involved), and BN narrowing. Our current CPRE technique includes a gradual tapered transition at the BN, and similar to our previous experience; a wider BN and shorter urethra.