Radical single stage reconstruction in failed exstrophy.

Staged repair of exstrophy-epispadias complex cases with initial bladder closure followed by epispadias and bladder neck repair at a later date is well documented. However, the role of single stage repair as a primary and salvage procedure after failed closure is not well established. A total of 12 male patients with bladder exstrophy has undergone single stage repair at our facility (10 secondary and 2 primary procedures). Mean age of the 10 patients referred for secondary repair was 5.5 years (8 months to 13 years). In this group there had been 16 previously unsuccessful attempts at bladder closure and 15 operations for epispadias repair. The 2 primary repair patients were 15 months and 13 years old. Continence was achieved by bladder neck reconstruction combined with epispadias repair and all cases were augmented by enterocystoplasty in conjunction with a Mitrofanoff channel. Pelvic osteotomy was performed in 3 cases. After bladder neck revision in 2 children all are dry day and night on clean intermittent catheterization and have a satisfactory cosmetic appearance. Single stage reconstruction of the exstrophy complex is a satisfactory method with a low morbidity for treating children in whom previous repair has failed. Its more extended role in the primary case requires further evaluation.