Outcomes of complete primary repair of bladder exstrophy–epispadias in adult patients in a tertiary care center

Introduction: Classic bladder exstrophy (BE) is a rare malformation of the genitourinary tract. The surgical reconstruction of the BE–epispadias complex is challenging. Complete primary repair of BE has offered the promise of improved bladder functional outcomes. Here, we present the outcome of five patients who have undergone complete primary repair of BE in terms of closure of the bladder and abdominal wall with eventual bladder continence, preservation of renal function, and cosmetic and functional reconstruction of the genitalia. Materials and Methods: The records of patients are analyzed retrospectively. The sample size is five patients; all adult patients are aged between 17 and 22 years. All are treated in a single stage. Bladder augmentation is done in every case, bladder neck repair is done using paraurethral tissue, primary abdominal closure is done with rotation-advancement abdominal flap, epispadias repair is done using modified Cantwell–Ransley procedure, and suprapubic ramus transverse minimal osteotomy lateral to insertion of rectus abdominis and adductor longus is done. All the patients are followed regularly. Minimum period of follow-up is 1 year. Results: All patients are continent. One patient has developed a urethro-cutaneous fistula at the base of the penis. All the patients are on clean intermittent self-catheterization. Conclusion: Complete primary repair of exstrophy (CPRE) offers a viable alternative to modern staged repair, with favorable continence and renal outcomes. Proper surgical execution in the first attempt is critical for long-term success, emphasizing the importance of good surgical technique. Further long-term studies are necessary to solidify CPRE’s role as the primary surgical approach for BE–epispadias complex.