Surgical Management of Extropy-Epispadias Complex: Early Results from a Tertiary Level Hospital in Bangladesh

The exstrophy-epispadias complex (EEC) presents with diverse clinical manifestations, affecting various bodily systems, including the urinary tract, pelvis, abdominal wall, genitalia, and spine. The prevalence is approximately 1 in 10,000 births, with a higher occurrence in males. This study aimed to assess the efficacy of surgical repair for EEC. The observational study analyzed medical records from the Department of Urology at Rangpur Medical College Hospital, a tertiary level facility in Bangladesh, covering the period from June 2018 to January 2021. Eight EEC cases were managed during this four-year duration. Following careful evaluation and pre-anaesthetic assessments, all patients underwent surgical reconstruction of the urinary bladder and urethra. In suspicious cases, biopsies from the bladder wall were taken. The results showed that all patients successfully underwent reconstruction procedures. Biopsies were obtained in three patients due to suspected abnormalities. One patient with bladder exstrophy experienced disruption of the anterior abdominal wall, requiring later secondary closure. Three patients developed urethra cutaneous fistula, which were subsequently managed through closure procedures. The average follow-up period was 2 years, but one patient was lost to follow-up. The suggested modified surgical approach demonstrated favorable outcomes, leading to substantial improvements in patients' social and psychological well-being. Despite the rarity of EEC, the surgical repair proved to be effective in addressing the complexities associated with the condition.