One-Stage Delayed Bladder Exstrophy Closure Combined With Kelly Repair: Early Outcomes Following the 100-Case Milestone.

Abstract

To evaluate bladder dehiscence after one-stage delayed closure of bladder/cloacal exstrophy combining bladder plate closure with Kelly procedure, with or without osteotomy. A multicenter retrospective study of children with bladder exstrophy or cloacal exstrophy who underwent single-stage closure with Kelly mobilization (October 2015-October 2025), by one surgical team, in France and tertiary centers abroad. The primary end point was bladder dehiscence within 3 months. Secondary end points were early (< 3 months) complications. Outcomes were analyzed separately for primary repairs and complex cases. A total of 123 patients were included (110 bladder exstrophy (89%), 13 cloacal exstrophy (11%); 76 men (62%)). The median age at surgery was 7.1 months (2.9-15.8); median follow-up 54 months (25-82). The reconstruction was a primary repair in 106 children (86%) and redo-closure after failed repair in 17/123 (14%). No bladder dehiscence occurred. Early complications arose in 23/123 children (19%), mainly wound-related (15/123, 12%) including infection/dehiscence (n = 6, 5%) and urinary fistula (9/123, 7%). Complications were Clavien-Madadi grade IV (n = 3, 2.4%) III-B (n = 4, 3.3%), III-A (n = 4, 3.3%), and I-B or II (n = 12, 10%). In multivariate analysis, abdominal closure with <i>rectus abdominis</i> muscles midline transposition was the only independent prognostic factor of wound complications (OR 4.47 [1.22-16.37] <i>P</i> = .02). Single-stage delayed closure combined with Kelly mobilization allows reliable bladder closure with no early dehiscence in bladder/cloacal exstrophy. Early morbidity rate was < 20%, with predominantly low-grade complications. When pubic approximation was difficult, osteotomies or fascial flaps appeared to offer better early parietal outcomes than rectus muscles transposition.