Bladder exstrophy (BE) repair in children often includes managing vesicoureteric reflux (VUR) conservatively until bladder neck reconstruction (BNR), followed by bilateral ureteric reimplantation (UR) to prevent kidney damage from high bladder pressures. However, delayed closure of the bladder template can restrict bladder growth, leading to the need for bladder augmentation using bowel segments. This study investigates whether bilateral UR remains necessary in cases requiring augmentation, as the augmented bladder helps dissipate pressure and may reduce the impact of VUR on the kidneys. A retrospective analysis was conducted on children who underwent BE repair from January 1999 to January 2019, examining baseline demographics, medical and surgical histories, clinical examination results, and radiological findings. Key surgical outcomes, complications, and long-term follow-up data were compared between those who received UR and those who did not.
Among the 51 children in the study, 24 underwent bilateral UR while 27 did not. Baseline characteristics, including age, gender, serum creatinine, estimated glomerular filtration rate (eGFR), and incidence of hydronephrosis, showed no statistically significant differences between the two groups. Similarly, there were no notable distinctions in surgical procedures between patients with and without UR. Postoperative follow-up revealed comparable outcomes across both groups in terms of median follow-up time, rates of clean intermittent catheterization (CIC), urinary tract infections (UTIs), postoperative hydronephrosis, and bladder capacity. Overall, this study indicates that bilateral UR may not be essential in BE repairs that require bladder augmentation post-infancy, as augmentation itself helps mitigate pressure-related risks, offering an alternative approach to managing VUR in these cases.
