{
    "abstract": "Following successful closure of patients with classic bladder exstrophy (CBE), the next major milestone is the establishment of urinary continence. Prior to determining the most appropriate continence surgery, it is imperative to reach an adequate bladder capacity minimum of 100\u00a0cc in order to make the decision between bladder neck reconstruction (BNR) or continent stoma, with or without augmentation cystoplasty (AC).\nTo examine the timing of when patients achieve threshold bladder capacity for BNR eligibility. We hypothesize most patients will achieve an adequate bladder capacity (100\u00a0cc) by 7 years old when continence surgeries will begin to be considered.\nAn institutional database of 1388 exstrophy patients was retrospectively reviewed for CBE patients after successful primary bladder closure. Bladder capacities were measured via gravity cystography and data presented as descriptive statistics. The cohort was stratified by location, neonatal (\u226428 days) or delayed closure period and osteotomy status. The bladder capacities were categorized to either reaching goal or not and a cumulative event analysis was performed. The event being reaching 100\u00a0cc capacity or greater and time being the number of years between bladder closure and attainment of goal capacity.\n253 patients met inclusion criteria between 1982 and 2019. The majority were of male gender (72.9%), had their closure performed at the authors' institution (52.5%), within the neonatal period (80.7%), and without an osteotomy (51.7%). 64.9% of patients reached goal bladder capacity. There were no significant differences in those who did or did not achieve goal except for clinical follow up. Cumulative event analysis demonstrated a median time of 5.73 years (95% CI 5.2-6.20) corresponded with a 50% event probability of reaching goal capacity. Cox-proportional hazards showed location of closure was significantly associated with hazards of reaching goal bladder capacity (HR\u00a0=\u00a00.58, CI 0.40-0.85, p\u00a0=\u00a00.005). Based on this model, the median time to event would be 5.20 years (95% CI 4.76-5.80) for cases done at the authors' hospital and 6.26 years for those performed at an outside hospital (95% CI 5.77-7.24).\nThese findings help surgeons counsel families appropriately on the odds of attaining goal capacity at various ages. For those who do not reach 100\u00a0cc by five years of age, it helps further characterize the odds of requiring a continent stoma with bladder augmentation and the best timing for reconstructive surgery in order to safely gain urinary continence. Families may also be assured that most patients would have the breadth of surgical options when it comes to continence as more than half of patients reached the bladder capacity threshold.",
    "authors": [
        {
            "affiliation": "James Buchanan Brady Urological Institute, Division of Pediatric Urology, Douglas A. Canning MD Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.",
            "firstname": "Preeya",
            "initials": "P",
            "lastname": "Khandge"
        },
        {
            "affiliation": "James Buchanan Brady Urological Institute, Division of Pediatric Urology, Douglas A. Canning MD Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.",
            "firstname": "Christian C",
            "initials": "CC",
            "lastname": "Morrill"
        },
        {
            "affiliation": "James Buchanan Brady Urological Institute, Division of Pediatric Urology, Douglas A. Canning MD Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.",
            "firstname": "Wayland J",
            "initials": "WJ",
            "lastname": "Wu"
        },
        {
            "affiliation": "James Buchanan Brady Urological Institute, Division of Pediatric Urology, Douglas A. Canning MD Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.",
            "firstname": "Kelly T",
            "initials": "KT",
            "lastname": "Harris"
        },
        {
            "affiliation": "James Buchanan Brady Urological Institute, Division of Pediatric Urology, Douglas A. Canning MD Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.",
            "firstname": "Ahmad",
            "initials": "A",
            "lastname": "Haffar"
        },
        {
            "affiliation": "James Buchanan Brady Urological Institute, Division of Pediatric Urology, Douglas A. Canning MD Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.",
            "firstname": "Mahir",
            "initials": "M",
            "lastname": "Maruf"
        },
        {
            "affiliation": "James Buchanan Brady Urological Institute, Division of Pediatric Urology, Douglas A. Canning MD Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.",
            "firstname": "Hiten D",
            "initials": "HD",
            "lastname": "Patel"
        },
        {
            "affiliation": "James Buchanan Brady Urological Institute, Division of Pediatric Urology, Douglas A. Canning MD Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.",
            "firstname": "Heather N",
            "initials": "HN",
            "lastname": "Di Carlo"
        },
        {
            "affiliation": "James Buchanan Brady Urological Institute, Division of Pediatric Urology, Douglas A. Canning MD Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, The Johns Hopkins Medical Institutions, Baltimore, MD, USA. Electronic address: jgearha2@jhmi.edu.",
            "firstname": "John P",
            "initials": "JP",
            "lastname": "Gearhart"
        }
    ],
    "conclusions": null,
    "copyrights": "Copyright \u00a9 2023 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.",
    "doi": "10.1016/j.jpurol.2023.04.039",
    "journal": "Journal of pediatric urology",
    "keywords": [
        "Bladder capacity",
        "Bladder exstrophy",
        "Bladder neck reconstruction",
        "Continence"
    ],
    "methods": null,
    "publication_date": "2023-05-29",
    "pubmed_id": "37246118",
    "results": "253 patients met inclusion criteria between 1982 and 2019. The majority were of male gender (72.9%), had their closure performed at the authors' institution (52.5%), within the neonatal period (80.7%), and without an osteotomy (51.7%). 64.9% of patients reached goal bladder capacity. There were no significant differences in those who did or did not achieve goal except for clinical follow up. Cumulative event analysis demonstrated a median time of 5.73 years (95% CI 5.2-6.20) corresponded with a 50% event probability of reaching goal capacity. Cox-proportional hazards showed location of closure was significantly associated with hazards of reaching goal bladder capacity (HR\u00a0=\u00a00.58, CI 0.40-0.85, p\u00a0=\u00a00.005). Based on this model, the median time to event would be 5.20 years (95% CI 4.76-5.80) for cases done at the authors' hospital and 6.26 years for those performed at an outside hospital (95% CI 5.77-7.24).",
    "title": "Achieving goal capacity for continence surgery: A cumulative event analysis of bladder exstrophy patients.",
    "xml": "<Element 'PubmedArticle' at 0x788506c30040>"
}