2020 Volume 56 Issue 7 Pages 1055-1060
Purpose: We perform single-stage reconstruction (SR) for cloacal exstrophy (CE). SR comprises the following steps: gastrointestinal tract reconstruction with colostomy, bladder and urethral closure, pubic approximation without osteotomy, and abdominal closure. Herein, we describe the procedure for each step of SR and postoperative management, and we review the outcomes of SR for CE.
Methods: The cases of six patients with CE who had undergone SR from 1990 to 2019 were reviewed. SR was performed within 48 hours of birth. Anticholinergic administration and clean intermittent catheterization were started soon after SR. Data were collected regarding surgical complications, bladder volume, and the achievement of urinary continence.
Results: The patients were four males and two females aged 3 to 26 years (mean 11.3 years). Four patients had omphalocele, and all patients had spinal anomaly. The pubis was approximated without osteotomy in all cases. Abdominal compartment syndrome occurred in one patient with a giant omphalocele prolapsing the liver. The urethral catheter was accidentally removed soon after SR in one patient; this patient developed urethral stenosis and required vesicostomy. Regarding late surgical complications, two patients needed surgery to relieve intestinal obstructions, and another patient needed recreation of the colostomy and vagina. Three patients became able to perform clean intermittent catheterization themselves at 7–10 years of age, and two of them achieved urinary continence at 10–15 years of age without undergoing continence procedures.
Conclusions: Our SR and postoperative management enables some patients with CE to achieve urinary continence, thus avoiding the need for multiple surgical procedures such as staged closure with osteotomy or continence procedures.
