Bladder exstrophy and epispadias Peter Cuckow
This chapter covers one of the most challenging conditions in paediatric urology. In addition to the complex surgery needed to correct the severe bladder abnormalities and genital deformities, there may be secondary problems relating to renal function and fertility. Because of the low incidence of bladder exstrophy and related conditions (Table 15.1), very few individual surgeons have had the opportunity to acquire sizeable series of patients. Even those working in major centres serving large populations may see only one or two new patients each year. In the UK it was therefore decided to concentrate bladder exstrophy surgery in two supraregional centres, thus enabling a smaller number of paediatric urologists to develop and maintain higher levels of expertise than was possible when cases were distributed between more centres. Concentrating exstrophy management in two supraregional centres has had the added benefit of facilitating the development of new treatment strategies and new clinical and
laboratory research initiatives which will hopefully contribute to improved outcomes for children born with this complex of severe anomalies.