Classic bladder exstrophy – the timing of initial closure and technical highlights
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Abstract
The timing for the initial reconstruction of the bladder and abdominal wall in classic bladder exstrophy (CBE) has typically been performed in the immediate newborn period in both the modern staged repair of exstrophy (MSRE) and the complete primary repair of exstrophy (CPRE) protocols. The benefit of immediate surgical closure (typically in the first 72 hours) was that many children could be managed without resorting to osteotomy due to the malleability of the pelvis. The concerns about the potential short and longer term impacts of osteotomy have waned mainly due to improvements in orthopaedic surgical management, the use of external fixation, and the ability to provide sedation and pain control to infants and children.1,2 Additionally, an ongoing understanding of how to protect the bladder template and permitting a too-small-to-close bladder template time to grow also influences the reasoning behind the timing of initial bladder closure. Two other social factors have also led to delaying immediate reconstruction: the desire to provide time for maternal/parental-child bonding and the accessibility of an appropriate centre for care with experts in the management of exstrophy.