Outcomes of Patients Operated for Exstrophy-EpispadiasComplex at Tikur Anbessa Specialized Hospital and Menelik-II Specialized Hospital, Addis Ababa, Ethiopia

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Addis Abeba University


Background: Exstrophy epispadias complex (EEC) is a spectrum of congenital abnormalities that involves urinary system, musculoskeletal system, pelvis, pelvic floor, abdominal wall, genitalia, and sometimes the spine and anus. It encompasses epispadias, classic bladder exstrophy, cloacal exstrophy and other exstrophy variants. The management of EEC is primarily surgical. The surgical procedures are either functional anatomic reconstruction (single staged or multiple staged) and urinary diversions. The principal goals of surgical reconstruction in EEC are achieving urinary continence with volitional voiding, preservation of renal function, and functional and cosmetic external genitalia. Objective: Describe the outcomes of patients operated for exstrophy epispadias complex at Tikur Anbessa Specialized Hospital (TASH) and Menelik II specialized Hospital (NH) from September 1 , 2012 up to August 31 st , 2019. Method: Retrospective descriptive study which assessed the outcomes of patients operated for exstrophy epispadias complex at TASH and MH from September 1 st , 2012 until August 31 Results: One hundred and forty patients with EEC operated during study period, 91 patients (18 isolated epispadias, 66 classic bladder exstrophy, 3 cloacal exstrophy, and 4 variant exstrophy) were included in the study. No patient diagnosed during pregnancy. The median age at first hospital presentation was 5 months (birth to 12 years), and first operation was done at median age of 48 months (4 days to 12 years). The commonest type of EEC was classic bladder exstrophy (71.4%). Associated congenital anomalies was found in 26 (28.6%) of patients. Primary urinary diversions were done for 23 (25.3%) patients. Functional anatomic reconstructive procedures were performed for 68 (74.7%) patients. Most patients with classic bladder exstrophy have failed anatomic functional reconstruction and require urinary diversion to achieve continence. Early postoperative complications occurred in 76 (89.4%) patients. Forty-two patients (29 Mainz pouch II, 7 augmentation ileocystoplasty with catheterizable stoma, 5 epispadias repair and 1 complete primary repair of bladder exstrophy) achieved urinary continence. More than half (52.3%) patients disappeared from their regular postoperative hospital visits. Conclusion: Urinary continence after anatomic functional reconstruction to EEC usually require urinary diversion (Mainz pouch II or augmentation ileocystoplasty) except in isolated epispadias. st , 2019.



Exstrophy epispadias complex,Patients