ONE-STAGE DELAYED BLADDER EXSTROPHY CLOSURE COMBINED WITH KELLY REPAIR: Early outcomes following the 100-case milestone

PURPOSE: To evaluate bladder dehiscence after one-stage delayed closure of bladder/cloacal exstrophy combining bladder plate closure with Kelly procedure, with or without osteotomy. MATERIALS AND METHODS: Multicenter retrospective study of children with bladder exstrophy or cloacal exstrophy who underwent single-stage closure with Kelly mobilization (October 2015-October 2025), by one surgical team, in France and tertiary centers abroad. The primary endpoint was bladder dehiscence within 3 months. Secondary endpoints were early (<3 months) complications. Outcomes were analyzed separately for primary repairs and complex cases. RESULTS AND CONCLUSION: muscles midline transposition was the only independent prognostic factor of wound complications (OR 4.47 [1.22-16.37] p= .02).Single-stage delayed closure combined with Kelly mobilization allows reliable bladder closure with no early dehiscence in bladder/cloacal exstrophy. Early morbidity rate was <20%, with predominantly low-grade complications. When pubic approximation was difficult, osteotomies or fascial flaps appeared to offer better early parietal outcomes than rectus muscles transposition.