A Comprehensive Review of the Complete Primary Repair Technique for Bladder-Exstrophy-Epispadias Reconstruction: First Surgical Attempt Should Be the Best One.

Abstract

Purpose: To evaluate the effectiveness of the Complete Primary Repair of Exstrophy (CPRE) technique for bladder exstrophy-epispadias complex (BEEC) reconstruction and its comparison with the Modern Staged Repair of Exstrophy (MSRE) technique.

Materials and methods: A comprehensive literature review of CPRE and MSRE was conducted, focusing on factors such as continence rates, postoperative outcomes, and complications. Various studies on pelvic biometry, surgical approaches, and long-term evaluations of renal function and continence were analyzed.

Results: CPRE demonstrates promising outcomes, particularly in resource-limited settings, by reducing the number of surgeries and associated risks compared to MSRE. Success rates for continence post-CPRE were higher when performed correctly in the first attempt, with fewer complications such as vesicoureteral reflux and hydronephrosis. Pelvic biometry assessments, including bladder neck placement and levator ani angle, were significant predictors of successful continence outcomes.

Conclusion: CPRE offers a viable alternative to MSRE, particularly in low-resource environments, with favorable continence and renal outcomes. Proper surgical execution in the first attempt is critical for long-term success, emphasizing the importance of surgeon expertise and postoperative care. Further long-term studies are necessary to solidify CPRE's role as the primary surgical approach for BEEC.