Bladder Re-Augmentation in Classic Bladder Exstrophy: Risk Factors and Prevention

To characterize the causes of re-augmentation in patients with classic bladder exstrophy.

A prospectively-maintained institutional database of 1327 exstrophy-epispadias complex patients was reviewed for CBE patients who have undergone more than one AC procedure. Data regarding bladder capacities, complications following AC, and reasons for re-augmentation were evaluated.

A total of 166 CBE patients underwent AC. Of these, 67 (40.4%) were included in the control group and 17 (10%) patients underwent a re-augmentation. There were several indications for re-augmentation including continued small bladder capacity (17/17), inadequate bladder necks (8/17), failed rattail augmentation (2/17), stomal incontinence (1/17), a urethrocutaneous fistula (1/17), and an hourglass augmentation (1/17). Of note, 5 (29%) of the 17 patients had a re-augmentation procedure with a ureteral reimplantation. The sigmoid colon was the most commonly used bowel segment in the failed initial AC (8 patients), while the ileum was the most commonly used segment during re-augmentation (12 patients). In the re-augmentation cohort, the mean amount of bowel used during the first AC procedure was 12 cm [SD 3.6] compared to 19 cm [SD 5.0] during re-augmentation. The mean amount of bowel used for control group augmentations was 20.8 cm [SD 4]. The mean re-augmentation pre-operative bladder capacity of 100 mL [SD 60] immediately increased after re-augmentation to 180.8 mL [SD 56.4] (p=0.0001).

Bladder re-augmentation is most commonly required in the setting of a small bladder capacity after an initial AC, when an insufficient amount of bowel is used during the first AC procedure.

Urology. 2018 Feb 12 [Epub ahead of print]

Karl Benz, John Jayman, Karen Doersch, Mahir Maruf, Timothy Baumgartner, Matthew Kasprenski, John P Gearhart

Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA., Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA; Texas A&M Health Science Center College of Medicine, Temple, TX, USA., Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA. Electronic address: .

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