Outcomes of Patients Operated for Exstrophy-EpispadiasComplex at Tikur Anbessa Specialized Hospital and Menelik-II Specialized Hospital, Addis Ababa, Ethiopia
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Date
2021-11
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Addis Abeba University
Abstract
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.
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Keywords
Exstrophy epispadias complex,Patients