Why Choose Us for Bladder Exstrophy

Dedicated pediatric urology experts

The Division of Urology at Children’s Hospital of Philadelphia is consistently ranked as one of the top pediatric urology programs in the nation. Our team is comprised of world leaders in pediatric urology who offer the full complement of surgical approaches to ensure each child functions to their potential. Each year we perform more than 2,000 surgeries and treat nearly 20,000 children — some of whom travel to us from around the world.

Collaborating to advance care

Bladder exstrophy, cloacal exstrophy, epispadias, and the bladder exstrophy-epispadias complex (BEEC) are rare and complex disorders. Many physicians see only one or two cases in their career. The Multi-Institutional Bladder Exstrophy Consortium (MIBEC) is a collaboration between three world-renowned institutions — Children’s Hospital of Philadelphia, Boston Children’s Hospital and Children’s Hospital of Wisconsin — dedicated to improving care and functional and cosmetic outcomes of children with all forms of bladder exstrophy.

The MIBEC team brings together some of the most experienced pediatric urologists in the nation who have more than 200 collective years of surgical experience. This team collaborates with orthopedic surgeons and pediatric anesthesiologists to provide expert surgical care that improves the quality of life, continence and body image for these children. For each surgery, pediatric urologists from MIBEC’s three-hospital team travel to the home institution to collaborate on surgical techniques to optimize patient outcomes.

By working together, we have quadrupled our experience and gained unmatched expertise in treating these rare conditions.

Dedicated to surgical safety

For each patient, our goal is to achieve the perfect anatomical closure. Our consistent step-by-step surgical approach from the initial incision through the last stitch of the closure ensures the best results. 

We have incorporated safety measures to ensure safety during surgery and improved continence after surgery and through adulthood. 

Prior to surgery, we identify the muscles critical to voiding to ensure they are protected during our reconstruction.

Improved outcomes

Our reconstructive approach — called the complete primary repair of exstrophy (CPRE) — allows us to achieve all the goals of surgical correction in one operation. It has resulted in substantial improvements in outcomes.

The CPRE allows for more normal bladder function to begin earlier and optimizes chances for long-term continence. More than 60% of the children we treat are able to void with dry intervals, with results improving as the child grows.  

A focus on the future

After surgical repair, these children require lifelong follow up. Regular follow-up clinic visits and ultrasounds at the institution where the surgery was performed are scheduled to monitor the bladder and kidneys as they grow.

Our team focuses on optimizing urinary control, appearance and function of the genitalia, and preservation of kidney function. Some children may need additional surgery as they get older to achieve continence or to complete the genital reconstruction.

We have developed an extensive physical therapy program that focuses on the development of core strength and pubic muscle coordination to help these children develop continence earlier without a secondary bladder neck reconstruction. We believe that the anatomic closure provided by the CPRE approach along with hard work and exercise result in better continence for these children.

Details of all patients’ operations are recorded and reviewed by the MIBEC team to guide long-term care, continually refine our approach. 

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