Outcomes of Bladder Augmentation and Bladder Neck Reconstruction in children with Bladder Exstrophy: A Single-Institution prospective Study

Hassan, Mohamed Abada; Gabr, Ahmed Khairi; Shehata, Sameh Mahmoud; Shams, Mohamed Abdelazim; Oshiba, Ahmed Mohamed

doi:10.21608/svuijm.2025.388180.2185

Outcomes of Bladder Augmentation and Bladder Neck Reconstruction in children with Bladder Exstrophy: A Single-Institution prospective Study

Document Type : Original research articles

Authors

Department of Pediatric Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt

10.21608/svuijm.2025.388180.2185

Abstract

Background: Bladder augmentation utilizing gastrointestinal segments, combined with bladder neck reconstruction, represents a critical surgical approach in the management of children with bladder exstrophy, particularly for addressing urinary incontinence. The primary objective of bladder augmentation is to establish a low-pressure, high-capacity urinary reservoir that optimizes functional storage.
Objectives: to assess the effectiveness, safety, and clinical outcomes of ileocystoplasty combined with a modified Young-Dees-Leadbetter bladder neck reconstruction and the creation of a continent catheterizable channel in pediatric patients diagnosed with bladder exstrophy. The research was conducted at the Pediatric Surgery Unit, Children’s Hospital, Faculty of Medicine, Alexandria University, Egypt.
Patients and methods: This prospective intermediate term follow up study included 20 patients with bladder exstrophy repair but subsequently presented with reduced bladder capacity (<100 mL), urinary incontinence, and clinical indications for bladder augmentation combined with bladder neck reconstruction. All patients were studied for operative time, intraoperative complications, post-operative ileus, post-operative wound infection and the need for secondary intervention procedure and post operatively for stoma complications, bladder capacity, continence, improvement of VUR and compliance on CIC.
Results: This study included 16 males (80%) and 4 females (20%), with a male-to-female ratio of 4:1. The age of patients at the time of the operation ranged from 5 to 11 years, with a mean ± SD (7.8 ± 2) years. Mean operative time was 4.4 hours. Only 3 cases needed bilateral ureteric reimplantation. Three cases developed postoperative wound infection. Two cases developed vesicocutaneous fistula. Two cases had stoma stenosis. There is 5 fold increase in bladder capacity. All cases showed resolution of VUR. Continence rate after the procedure was 80%.
Conclusion: Bladder augmentation with bladder neck reconstruction and the creation of a continent catheterizable channel represents a safe and effective surgical approach for managing bladder exstrophy patients with urinary incontinence and reduced bladder capacity. These procedures have demonstrated significant efficacy in enhancing bladder volume, improving compliance, resolving VUR, improving continence and improving quality of life.

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