Our initial experience with the technique of complete primary repair for bladder exstrophy.

OBJECTIVE We reviewed our initial results with complete primary repair of exstrophy in regard to continence status and the need for subsequent continence procedures. PATIENTS AND METHODS We performed a retrospective review of our surgical records from 1996 to 2008 to identify all patients with bladder exstrophy managed at our center. RESULTS Sixteen children were closed successfully. Six patients (37.5%) experienced complications: umbilical hernias in two, transient penopubic fistula in three, and subcoronal fistula due to meatal stenosis in one. Of the 12 males, seven (58.3%) were left with a hypospadias at the time of primary closure. Two (22.2%) children required a formal bladder neck reconstruction to achieve continence. Bladder augmentation and continent catheterizable stoma was performed in four cases (44.4%), and bladder neck injection in one case (11.1%). Bladder neck closure was also performed in another child following primary closure. Three of these children are continent and void spontaneously (33.3%). The remaining six require clean intermittent catheterization four to six times a day, resulting in four (44.4%) being continent. The number of continence procedures and mean number per patient were 15 and 1.66, respectively. CONCLUSION Our early experience with this technique has been encouraging, with few major complications, a highly successful closure rate and a cosmetically normal result.