Late failure of the reconstructed exstrophy bladder

OBJECTIVE: To establish whether successful bladder closure and bladder neck reconstruction in patients with exstrophy is durable into adulthood and whether bladder outlet obstruction, created during bladder-neck tightening procedures, may lead ultimately to detrusor or urethral failure. PATIENTS AND METHODS: The outcome of 57 patients born with exstrophy between 1965 and 1974 was reviewed. RESULTS: Of the 32 babies who underwent reconstruction, 19 failed in childhood and 13 still retained a native bladder into their second decade. Eight of 13 children with successful bladder closures and bladder neck reconstructions required further reconstruction or continent diversion in the second decade of life, most commonly because of poorly compliant, low-capacity bladders associated with incontinence. Six had an augmentation cystoplasty (five with a continence procedure as well) and two had an artificial sphincter alone. Two patients have retained their native bladder but require self-catheterization. CONCLUSION: Long-term follow-up of patients with initially successful exstrophy closures is required, as late detrusor or urethral failure may occur. This detrusor failure may be related to bladder outlet obstruction associated with bladder neck reconstruction.