The success of the initial closure of the complex
bladder-exstrophy remains a challenge in pediatric surgery. This study describes a personal experience of the causes of failure of the initial closure and operative morbidity during the surgical treatment of
bladder-exstrophy complex. From April 2000 to March 2014, four patients aged 16 days to 7 years and 5 months underwent complex exstrophy-
epispadias repair with pelvic
osteotomies. There were three males and one female. Three of them had posterior pelvic
osteotomy, one had anterior innominate
osteotomy. Bladder Closure: Bladder closure was performed in three layers. Our first patient had initial bladder closure with
polyglactin 4/0 (
Vicryl ® 4/0), concerning the last three patients, initial bladder closure was performed with
polydioxanone 4/0 (PDS ® 4/0). The bladder was repaired leaving the urethral
stent and ureteral
stents for full urinary drainage for three patients. In one case, only urethral
stent was left, ureteral drainage was not possible, because
stents sizes were more important than the ureteral diameter. Out of a total of four patients, initial bladder closure was completely achieved for three patients. At the immediate postoperative follow-up, two patients presented a complete disunion of the abdominal wall and bladder despite an appropriate
postoperative care. The absorbable braided
silk (
polyglactin) used for the bladder closure was considered as the main factor in the failure of the bladder closure. The second cause of failure of the initial bladder closure was the incomplete urine drainage, ureteral catheterisation was not possible because the
catheters sizes were too large compared with the diameters of the ureters. The failure of the initial
bladder-exstrophy closure may be reduced by a closure with an absorbable monofilament
silk and efficient urine drainage via ureteral catheterisation.