The impact of classic bladder exstrophy-epispadias repair in adult patients without continence


  • Vinayak J. Shenage Department of Surgery, SMBT IMSRC, Nandi Hills, Dhamangaon, Ghoti, Igatpuri, Nashik, Maharashtra, India
  • Sanjay P. Dhangar Department of Surgery, SMBT IMSRC, Nandi Hills, Dhamangaon, Ghoti, Igatpuri, Nashik, Maharashtra, India
  • Awais A. Syed Department of Surgery, SMBT IMSRC, Nandi Hills, Dhamangaon, Ghoti, Igatpuri, Nashik, Maharashtra, India
  • Manisha Shengal Department of Surgery, SMBT IMSRC, Nandi Hills, Dhamangaon, Ghoti, Igatpuri, Nashik, Maharashtra, India



Adult bladder exstrophy, Exstrophy-epispadias complex, Epispadias repair without osteotomy


Background: Bladder exstrophy-epispadias complex is a rare congenital anomaly. Very few patients grow with the condition intact in their adulthood which lead to compromise in the results of repair. We herein report our experience of correction of the defects in the adult patients in single stage without doing osteotomy andurinary diversion.
Methods: The sample size was 13 patients over ten years. All were treated in single stage. Bladder neck repair was done using paraurethral tissue, primary abdominal closure was done without flap, epispadias repair was done using modified Cantwell-Ransley procedure and hernial repair was done without mesh. No osteotomy was done. All the patients were followed regularly. Minimum period of follow-up was one year. Urinary continence, change in habits and subjective assessment of well-being were also noted.

Results: 86.4% patients were totally incontinent. Bladder and anterior abdominal wall were closed in all the patients. Complete epispadias was possible in15.3% patients and rest were converted into coronal hypospadias. Hernia was repaired in 23% patients. All the patients were satisfied with their cosmetic results and they were able to interact socially.
Conclusions: Surgical correction of the exstrophy-epispadias complex is possible in adulthood in the hands of experts in single stage without osteotomy. Regular cystoscopic examination and urine cytology yearly are recommended to diagnose the malignant changes in the native bladder as early as possible. Psychological, social and self-level of satisfaction is high among these patients after the surgical correction.


Lancaster PAL. Epidemiology of bladder exstrophy and epispadias: a communication from the International clearinghouse for birth defects monitoring system. Teratol. 1987;36:221.

Gearhart JP, Jeffs RD. Management of the exstrophy-epispadias complex and urachal anomalies. In: Walsh PC, eds. Campbell's Urology. Philadelphia: Saunders; 1992:1772-821.

Lattimer JK, Smith MJK. Exstrophy closure: A followup on 70 cases. J Urol. 1966;95:356.

Jeffs RD, Guice SL, Oesch J. The factors in successful exstrophy closure. J Urol. 1982;127:974.

Nelson CP, Dunn RL, Wei JT. Contemporary epidemiology of bladder exstrophy in the United States. J Urol. 2005;173(5):1728-31.

Gearhart JP, Mathews R. Exstrophy-epispadias complex. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 9th ed. Philadelphia: Saunders Elsevier; 2007:3497.

Mensah JE, Asante EK, Mensah WA, Glover-Addy H. continence Cutaneous Diversion for Bladder Exstrophy in Adults. African J Urol. 2013;19:94-8.

Aspects of psychology. Available at: https://positi Accessed on 20 March 2021.

Mansour AM, Sarhan, Helmy TE, Awad B, Dawaba MS, Ghali AM. Management of bladder exstrophy epispadias complex in adults: is abdominal closure possible without osteotomy? World J Urol. 2010;28 (2):199-204.

Jana A, Maiti K, Mondal TK, Majhi TK. Management of the exstrophy-epispadias complex in adolescents and adults. African J Urol. 2017;23(2):100-4.

Perlin DV, Sapozhnikov AD, Darenkov SP, Efremov EA. Treatment of exstrophy of bladder in adults. Urol. 2014;45(5):121-4.

Pathak HR, Mahajan R, Ali NI, Kaul S, Andankar MG. Bladder preservation in adult classic exstrophy: early results of four patients. Urol. 2001;57(5):906-10.

Ahmed IS, Ismail S. Management of bladder exstrophy in adulthood: report of 5 cases: J Pediatr Urol. 2013;9(5):575-8.

Smeulders N, Woodhouse C. Neoplasia in adult exstrophy patients. BJU Int. 2010; 87:623-8.

Nerli RB, Kamat GV, Alur SS, Ashish K, Prabha V. Bladder exstrophy in adulthood: Indian J Urol. 2008;24(2):164-8.






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