Sustained Collaboration Meets Needs for Bladder Exstrophy
FRIDAY, March 9, 2018 -- International collaboration focused on treating bladder exstrophy-epispadias complex (BE) and penopubic epispadias (PE) in India is associated with acceptable outcomes, according to a study published online March 7 in JAMA Surgery.
Rakesh S. Joshi, M.D., from the B.J. Medical College and Civil Hospital in Ahmedabad, India, and colleagues examined whether a collaboration predicated on long-term commitment by surgeons returning to the same institution annually combined with an experienced host surgical team and infrastructure could provide surgical care with acceptable outcomes in a study conducted in Ahmedabad, India, between January 2009 and January 2015. Comprehensive examination, measurement of continence outcomes, and assessment of surgical complications were conducted during recall of the postoperative cohort in January 2016. Fifty-seven patients who underwent complete primary repair of exstrophy returned for annual follow-up and made up the study cohort (23 with primary BE; 19 with redo BE, and 11 with PE repair).
The researchers found that all BE and three PE repairs (27 percent) were completed with concurrent anterior pubic osteotomies. Thirty-two percent of the patients experienced complications; only one patient with BE (4 percent) had bladder dehiscence and underwent repair the following year.
"A unique surgical mission model consisting of an international collaborative focused on treating the complex diagnoses of BE and PE offers outcomes comparable with those in high-income countries," the authors write. "Postoperative care following a systematized algorithm and rigorous follow-up is mandatory to ensure safety and optimal outcomes."
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Posted: March 2018