Scripties UMCG - Rijksuniversiteit Groningen
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Long-term clinical outcomes after reconstructive surgery in adults born with bladder exstrophy

(2017) Abu Al Makarem, M. (Mojah)

The classic bladder exstrophy (extrophia vesica) is one of the rare congenital anomalies that falls under the spectrum of the exstrophy-epispadias complex (EEC) along with cloacal exstrophy and epispadias. The pathogenesis is not completely understood but most theories are based on a midline defect. The classical bladder exstrophy is the most common of all three and boys are more frequently affected. The literature shows the effects of bladder exstrophy reconstructive surgery on the long-term clinical outcomes of the patients. This study examines the long-term clinical outcomes in the patients followed at the UMCG.
The aim of this study is to evaluate renal function in the patients, to determine whether they frequently suffer from urinary tract infections and if they are dry or suffer from urinary incontinence. Besides this, the metabolic effects (i.e. pH and vitamin B12 levels) as well as stone formation risk following bladder augmentations will be analysed.
Material and methods
Sixty-one adult patients born with bladder exstrophy were identified at the department of urology at the UMCG. Forty-eight patients were included in the study; 13 were excluded for various reasons. All the data were retrospectively retrieved from the medical files of patients.
The median age of the patients was 36 years. Of the 48 included patients, 56% were women and 44% were men. Sixty-nine percent of the patients were dry either by spontaneous voiding or by continent urine deviation, while 31% were incontinent (incontinent stoma, completely incontinent). Eighty-three percent of patients had a normal renal function. Thirty-one patients had suffered a urinary tract infection at least once in the last five years, while nine patients had experienced more than 3 urinary tract infections in the past three years. Sixteen patients (33%) developed stones; 13 had an augmented bladder. Only one patient with an augmented bladder was vitamin B12 deficient.
Bladder exstrophy does not have a negative influence on the renal function, nor on stone formation and vitamin B12 levels in the long term. There is no significant correlation between acidosis and bladder augmentation. This study population reported a higher number of urinary tract infections than occurs in the Dutch population with no preference for either gender. Finally, the majority of patients are dry and do not suffer from urinary incontinence.

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