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Introduction: With a focus on increasing experience and proficiency in the care of bladder exstrophy (BE), the Multi-Institutional BE Consortium (MIBEC) commenced in February 2013. Our objectives are to report short-term outcomes and early lessons learned from this unique model of continuing surgical education.
Materials & Methods: Three institutions served as hosts with observation, commentary and critique by collaborating surgeons. Employing the MIBEC method and protocol, CPRE with bilateral iliac osteotomy was performed at 1-3 months of age facilitating parental bonding, genitalia development, and organ system maturation. Patients were prospectively followed for outcomes including complications.
Results: From February 2013-February 2015, MIBEC participants performed CPRE in 28 consecutive patients (23 classic BE, 5 epispadias). Thirteen girls and 15 boys underwent CPRE at median age of 2.27 months (0.13-51.62 months). There were no dehiscences, and 18 patients are without complications. One boy had a hypospadiac urethral meatus at CPRE completion. Six girls had at least 1 episode of pyelonephritis, 2 boys developed urethrocutaneous fistula, and 4 girls had varying degrees of urinary retention requiring temporary clean intermittent catheterization (CIC). Complete retention developed in 2 of these 4 girls; 1 with a stenotic bladder outlet will require diversion to vesicostomy, and 1 with meatal stenosis resulting in bladder rupture continues CIC after repair.
Conclusions: Technical refinement of CPRE remains an ongoing process. This collaborative model is feasible and can be transferred to other rare, complex surgical procedures to maximize and share collective expertise, standardize technique, and analyze outcomes to ultimately benefit patient care.