Abstract
The 12-year experience at our hospital with
epispadias and incontinence is reviewed and attention is focused on the
approach to patients with a small bladder capacity. Of 29 children 20 had
incontinence associated with the epispadias (13 boys and 7 girls). A total of
15 patients underwent definitive management of the incontinence with a
Young-Dees bladder neck reconstruction with or without ureteral reimplantation
and they are evaluable. Nine patients (6 boys and 3 girls) had a bladder
capacity that was believed to be inadequate for satisfactory bladder neck
reconstruction (less than 60 ml.). To date, 7 of these children have undergone
staged reconstruction with urethroplasty for epispadias as the initial
operation. Bladder capacity increased 95 ml. on the average (range 60 to 140
ml.) after the urethroplasty. No child had hydronephrosis before or after
bladder neck reconstruction. Review of the results of bladder neck
reconstruction in all patients with a mean follow up of 2.9 years (range 7
months to 13 years) demonstrates an 87 per cent satisfactory continence rate (9
of 9 boys and 4 of 6 girls). In the patients who underwent staged
reconstruction the results were similar, with a 100 per cent continence rate in
evaluable patients (5 of 5 boys and 2 of 2 girls).
In conclusion, urethroplasty before bladder neck
reconstruction in the epispadiac child with a small bladder allows an increase
in capacity, thus, obviating for the most part the need for procedures such as
bladder augmentation in the majority of these patients.