Anatomical correction of the exstrophy–epispadias complex: analysis of 34 patients.

Objective To evaluate the surgical procedures required for anatomical reconstruction of the bladder and penis in the exstrophy–epispadias complex. Patients and methods All primary exstrophy–epispadias repairs carried out by one surgeon between 1987 and 1997 were reviewed. Bladder closure consisted of full extraperitoneal mobilization, transpositional omphaloplasty, drainage with ureteric and urethral catheters and immobilization with a ‘frog-leg’ plaster-cast or ‘mermaid’ dressings. Osteotomies were always performed when bladder closure was attempted after 37 h of age. Before 1990 the osteotomies were posterior vertical iliac (one patient) and subsequently anterior oblique iliac (10 patients). Pre-peritoneal herniotomies, in the absence of a clinical hernia, were included in the primary procedure after 1992. A modified Cantwell technique was used for epispadias repair and this was undertaken at a median of 16 months after bladder closure (range 6–30). Results Thirty-four patients (27 male) were reviewed; one patient had a chromosomal abnormality, a deletion in the short arm of chromosome 4. The male infants required a median of four procedures (range 2–5) for bladder closure, epispadias reconstruction and herniotomies, while the females needed a median of two (range 2–5). Complete bladder dehiscence, requiring re-closure with osteotomies, occurred in three cases (9%, two male). There were no dehiscences in the primary osteotomy group. Fistulae after epispadias repair occurred in four patients (17%). The bladder capacity increased to >60 mL in 10 of 15 males by 36 months after epispadias repair. Only two of seven female infants attained a capacity of >60 mL. Of the 15 infants who did not undergo herniotomy at primary closure, 13 subsequently developed inguinal hernias (one uni- and 11 bilateral) with incarceration occurring in two. Twelve infants underwent herniotomy at primary closure and six... [ABSTRACT FROM AUTHOR]