Abstract
Introduction The aim of the study is to review the continence and volitional voiding rate in a
single center cohort of exstrophy–epispadias patients following Young-Dees-Leadbetter
bladder neck reconstruction and to explore factors which predict continence.
Materials and Methods Children who underwent Young-Dees-Leadbetter bladder neck reconstruction as a final
stage of repair in a large single low-volume center in a small-population country
between 1997 and 2019 were included. Demographic and clinical details were extracted
from the patients' charts. The primary end point was continence and volitional voiding.
Patients were categorized as incontinent, socially continent (daytime dry intervals > 3 hours,
wet nights) and fully continent (daytime dry intervals > 3 hours, dry nights).
Results The study cohort included 27 patients whose median age at reconstruction was 5 years,
and median follow-up was 7.8 years (interquartile range [IQR] 6–11.2). The cohort
included 24 classic exstrophy patients (89%, 17 males and 7 females) and 3 isolated
complete epispadias patients (11%, 1 male and 2 females). Nine (33%) patients achieved
full continence and social continence was achieved by nine (33%) patients, for an
overall social continence rate of 67%. Preoperative bladder capacity of 110 mL or
more was associated with achieving social continence (odds ratio = 6.4, p = 0.047). The overall volitional voiding rate was 67%.
Conclusion Young-Dees-Leadbetter bladder neck reconstruction yielded rates of 33% for full continence
and 67% for social continence and volitional voiding. These rates are comparable to
those of large high-volume centers. A preoperative capacity of 110 mL or more was
the sole predictor of social continence.
Keywords
bladder exstrophy - urinary incontinence - outcome - reconstructive surgery
