An initial report of a novel multi-institutional bladder exstrophy consortium: a collaboration focused on primary surgery and subsequent care. J Urol 2015 May;193(5 Suppl):1802-7
Date
03/31/2015Pubmed ID
25813562DOI
10.1016/j.juro.2014.10.114Scopus ID
2-s2.0-84927912011 (requires institutional sign-in at Scopus site) 31 CitationsAbstract
PURPOSE: For bladder exstrophy repair it is universally accepted that successful initial surgery is paramount to achieve the optimal outcome. Gaining the necessary surgical experience is challenging due to the rarity of bladder exstrophy. We report preliminary findings of a multi-institutional collaboration created to increase experience and proficiency with the care of bladder exstrophy.
MATERIALS AND METHODS: Our 3 institutions alternatively served as the host site for scheduled surgeries with observation, commentary and critique by visitors from the other sites. The technique was complete primary repair with bilateral iliac osteotomy. The timing of complete primary repair at age 1 to 3 months facilitated collaboration. We recorded patient demographics and outcomes, and the impact of this collaboration on our technique and experience. Video recording was used for real-time observation and teaching, and future analysis, editing and review.
RESULTS: A total of 16 site visits occurred from February 2013 through May 2014. Complete primary repair was performed in 9 males and 7 females with bladder exstrophy. Median age at complete primary repair was 2 months (range 0.1 to 28.8). Median followup was 8.9 months (range 2.8 to 18.2). All closures were successful with no dehiscence. Complications included urethrocutaneous fistula in 2 patients, 1 episode of pyelonephritis in 3 each and urethral obstruction in 2 females, of whom 1 required clean intermittent catheterization.
CONCLUSIONS: We report a multi-institutional collaboration to standardize the surgical management of bladder exstrophy. This effort increased the annual experience of each institution involved from threefold to ninefold and it has accelerated the physician knowledge base to ultimately benefit patient care.
Author List
Borer JG, Vasquez E, Canning DA, Kryger JV, Mitchell MEAuthors
John V. Kryger MD Chief, Professor in the Urologic Surgery department at Medical College of WisconsinMichael Edward Mitchell MD Chief, Professor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentAdult
Bladder Exstrophy
Child
Child, Preschool
Clinical Competence
Cooperative Behavior
Female
Humans
Infant
Male
Quality Improvement
Urogenital Surgical Procedures
Young Adult
