{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:05:44Z","timestamp":1787789144653,"version":"build-2784847793"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>\n                    A\n                    <jats:sc>BSTRACT<\/jats:sc>\n                  <\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Bladder exstrophy\u2013epispadias complex (BEEC) requires complex reconstruction, yet long-term comparative outcomes from low- and middle-income countries are limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>\n                      This Indian Association of Pediatric Surgeons (IAPS) multicenter, retrospective cohort study included 59 patients (2000\u20132020) stratified into modern staged repair of exstrophy (MSRE,\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 20), complete primary reconstruction of exstrophy (CPRE,\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 35), and radical soft-tissue mobilization (RSTM,\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 4). Outcomes included continence (Likert scale 1\u20135), bladder capacity, complications, reoperations, QoL, and predictors of continence.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The mean continence score was 3.47 \u00b1 0.97 (95% confidence interval [CI]: 3.22\u20133.73). CPRE (4.15 \u00b1 1.11) and RSTM (4.0 \u00b1 1.29) significantly outperformed MSRE (3.02 \u00b1 0.97) (Bonferroni:\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001). Acceptable continence (\u22654) was achieved in 54.3% CPRE, 50% RSTM, and 30% MSRE. Regression analysis showed earlier surgery (\u03b2 =0.31,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.005), CPRE (\u03b2 = \u22120.53,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.013), and bladder neck reconstruction (\u03b2 = \u22120.33,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.021) as independent predictors, while osteotomy was not significant (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.35). Mean bladder capacity was 146.4 \u00b1 96.8 cc (95% CI: 121.1\u2013171.6), highest in CPRE (248.2 cc) versus RSTM (152.5 cc) and MSRE (132.1 cc). Complications varied: bladder dehiscence occurred in 40% MSRE versus 5.7% CPRE and 0% RSTM; urinary tract infection\/VUR in 12% overall, highest in RSTM (50%); upper tract dilatation in 22.9% CPRE only. Reoperations were required in 45% MSRE versus 51.4% CPRE and 25% RSTM. QoL scores were higher in CPRE (3.7 \u00b1 1.01) and RSTM (3.75 \u00b1 1.24) than MSRE (2.97 \u00b1 0.92). Sexual and reproductive outcomes were poorly documented (&lt;15% assessed).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>CPRE demonstrated the most favorable long-term outcomes, with significantly better continence, higher bladder capacities, fewer reoperations, and superior quality of life compared with MSRE. RSTM yielded encouraging results but requires larger cohorts. This IAPS study identifies early surgery and bladder neck reconstruction as key predictors of success, while underscoring the urgent need for standardized, prospective surveillance of renal, sexual, and reproductive health in BEEC patients and need for longer follow-up.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jiaps.jiaps_339_25","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T19:00:30Z","timestamp":1773082830000},"page":"230-238","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Long-term Outcomes of Bladder Exstrophy\u2013Epispadias Complex: A Multicenter Study by Indian Association of Pediatric Surgeons"],"prefix":"10.4103","volume":"31","author":[{"given":"Kirtikumar J.","family":"Rathod","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikesh","family":"Agrawal","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Netaji Subhash Chandra Bose Government Medical College, Jabalpur, Madhya Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramesh","family":"Babu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Himanshu","family":"Acharya","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Netaji Subhash Chandra Bose Government Medical College, Jabalpur, Madhya Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinay","family":"Chandrashekhar","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, Narayana Health, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay","family":"Rao","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Narayana Health Hospitals, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santosh B.","family":"Kurbet","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, KAHER\u2019s J. N. Medical College, Belagavi, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahantesh V.","family":"Patil","sequence":"additional","affiliation":[{"name":"Department of Paediatric Nephrology, KAHER\u2019s J. N. Medical College, Belagavi, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandip Kumar","family":"Rahul","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, All India Institute of Medical Sciences, Deoghar, Jharkhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rupesh","family":"Keshri","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, All India Institute of Medical Sciences, Deoghar, Jharkhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pradnya S.","family":"Bendre","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, B. J. Wadia Hospital for Children, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shilpa","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narendra","family":"Babu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Indiragandhi Institute of Childhood Health, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shubhalaxmi","family":"Nayak","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumitra Kumar","family":"Biswas","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, NRS Medical College and Hospital, Kolkata, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,2,16]]},"reference":[{"key":"R1-20260311","doi-asserted-by":"crossref","first-page":"2056","DOI":"10.1016\/j.juro.2011.07.022","article-title":"Register based study of bladder exstrophy-epispadias complex: Prevalence, associated anomalies, prenatal diagnosis and survival","volume":"186","author":"Jayachandran","year":"2011","journal-title":"J Urol"},{"key":"R2-20260311","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s12301-023-00356-4","article-title":"Current management of bladder exstrophy epispadias complex in the modern era","volume":"29","author":"Morrill","year":"2023","journal-title":"Afr J Urol"},{"key":"R3-20260311","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1016\/j.urology.2010.12.086","article-title":"A novel midline scroto-perineal approach facilitating innervation preserving sphincteroplasty and radical corporal detachment for reconstruction of exstrophy-epispadias","volume":"78","author":"Kureel","year":"2011","journal-title":"Urology"},{"key":"R4-20260311","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1016\/j.eururo.2019.03.019","article-title":"Lifelong congenital urology: The challenges for patients and surgeons","volume":"75","author":"Wood","year":"2019","journal-title":"Eur Urol"},{"key":"R5-20260311","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1016\/j.juro.2011.12.011","article-title":"Adult care of children from pediatric urology","volume":"187","author":"Woodhouse","year":"2012","journal-title":"J Urol"},{"key":"R6-20260311","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.jpurol.2023.06.028","article-title":"Long term outcomes in Bladder Exstrophy Epispadias Complex \u2013The adult picture","volume":"20","author":"Harris","year":"2024","journal-title":"J Pediatr Urol"},{"key":"R7-20260311","doi-asserted-by":"crossref","first-page":"158","DOI":"10.4103\/0971-9261.186544","article-title":"The long-term outcomes after staged repair of exstrophy-epispadias complex","volume":"21","author":"Khemchandani","year":"2016","journal-title":"J Indian Assoc Pediatr Surg"},{"key":"R8-20260311","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1046\/j.1464-410X.2003.04244.x","article-title":"Urogynaecological and obstetric issues in women with the exstrophy-epispadias complex","volume":"91","author":"Mathews","year":"2003","journal-title":"BJU Int"},{"key":"R9-20260311","doi-asserted-by":"crossref","first-page":"382","DOI":"10.4103\/0970-1591.105747","article-title":"Exstrophy epispadias complex- issues beyond the initial repair","volume":"28","author":"Mahajan","year":"2012","journal-title":"Indian J Urol"},{"key":"R11-20260311","first-page":"1","article-title":"A comprehensive review of the complete primary repair technique for bladder-exstrophy-epispadias reconstruction: First Surgical Attempt Should Be the Best One","volume":"22","author":"Torabinavid","year":"2025","journal-title":"Urol J"},{"key":"R12-20260311","doi-asserted-by":"crossref","first-page":"34.e1","DOI":"10.1016\/j.jpurol.2022.04.018","article-title":"Kidney Function outcomes in patients after complete primary repair of bladder exstrophy and penopubic epispadias: Results from the international bladder exstrophy consortium","volume":"19","author":"Joshi","year":"2023","journal-title":"J Pediatr Urol"},{"key":"R13-20260311","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1097\/JU.0000000000003971","article-title":"Multi-institutional bladder exstrophy consortium after 8 years: The short- and intermediate-term outcomes","volume":"212","author":"Weiss","year":"2024","journal-title":"J Urol"},{"key":"R14-20260311","doi-asserted-by":"crossref","first-page":"370.e1","DOI":"10.1016\/j.jpurol.2023.03.013","article-title":"Long term renal outcome and risk of elevated blood pressure in children undergoing complete primary repair of bladder exstrophy (CPRE)","volume":"19","author":"Kanabolo","year":"2023","journal-title":"J Pediatr Urol"},{"key":"R15-20260311","doi-asserted-by":"crossref","first-page":"394.e1","DOI":"10.1016\/j.jpurol.2017.03.036","article-title":"Long-term fate of the upper tracts following complete primary repair of bladder exstrophy","volume":"13","author":"Ellison","year":"2017","journal-title":"J Pediatr Urol"},{"key":"R16-20260311","doi-asserted-by":"crossref","first-page":"433.e1","DOI":"10.1016\/j.jpurol.2020.05.011","article-title":"Continence after BNR in the complete repair of bladder exstrophy (CPRE): A single institution expanded experience","volume":"16","author":"Di Carlo","year":"2020","journal-title":"J Pediatr Urol"},{"key":"R17-20260311","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.jpurol.2020.01.004","article-title":"Complete primary repair of bladder exstrophy: A systematic review","volume":"16","author":"Pathak","year":"2020","journal-title":"J Pediatr Urol"},{"key":"R18-20260311","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1111\/j.1464-410X.2003.04518.x","article-title":"Long-term results of bladder neck reconstruction for incontinence in children with classical bladder exstrophy or incontinent epispadias","volume":"92","author":"Mouriquand","year":"2003","journal-title":"BJU Int"},{"key":"R19-20260311","doi-asserted-by":"crossref","first-page":"177","DOI":"10.2106\/00004623-199502000-00003","article-title":"The anatomy of the pelvis in the exstrophy complex","volume":"77","author":"Sponseller","year":"1995","journal-title":"J Bone Joint Surg Am"},{"key":"R20-20260311","doi-asserted-by":"crossref","first-page":"43","DOI":"10.4103\/0971-9261.78128","article-title":"The management of bladder exstrophy: Indian scenario","volume":"16","author":"Bhatnagar","year":"2011","journal-title":"J Indian Assoc Pediatr Surg"},{"key":"R21-20260311","doi-asserted-by":"crossref","first-page":"549","DOI":"10.4103\/0970-0358.122015","article-title":"A retrospective analysis of early experience with modified complete primary repair of exstrophy bladder (CPRE) in neonates and children","volume":"46","author":"Kurbet","year":"2013","journal-title":"Indian J Plast Surg"},{"key":"R22-20260311","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1007\/s00383-002-0777-4","article-title":"A new technique for repair of exstrophy-epispadias complex","volume":"18","author":"Kulkarni","year":"2002","journal-title":"Pediatr Surg Int"},{"key":"R23-20260311","doi-asserted-by":"crossref","first-page":"5.e1","DOI":"10.1016\/j.jpurol.2014.11.023","article-title":"Mobilization of pelvic musculature and its effect on continence in classical bladder exstrophy: A single-center experience of 38 exstrophy repairs","volume":"11","author":"Varma","year":"2015","journal-title":"J Pediatr Urol"},{"key":"R24-20260311","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1016\/j.jpurol.2015.08.007","article-title":"The radical soft-tissue mobilization (Kelly repair) for bladder exstrophy","volume":"11","author":"Leclair","year":"2015","journal-title":"J Pediatr Urol"},{"key":"R25-20260311","doi-asserted-by":"crossref","first-page":"110","DOI":"10.3389\/fped.2019.00110","article-title":"Recent trends in the management of bladder exstrophy: The Gordian knot has not yet been cut","volume":"7","author":"Promm","year":"2019","journal-title":"Front Pediatr"},{"key":"R26-20260311","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1016\/j.jpurol.2018.07.013","article-title":"One-stage combined delayed bladder closure with Kelly radical soft-tissue mobilization in bladder exstrophy: Preliminary results","volume":"14","author":"Leclair","year":"2018","journal-title":"J Pediatr Urol"},{"key":"R27-20260311","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.jpurol.2006.09.009","article-title":"Modern staged repair of bladder exstrophy: A contemporary series","volume":"3","author":"Baird","year":"2007","journal-title":"J Pediatr Urol"},{"key":"R28-20260311","doi-asserted-by":"crossref","first-page":"C:321","DOI":"10.1002\/ajmg.c.30316","article-title":"Bladder exstrophy: An epidemiologic study from the International Clearinghouse for birth defects surveillance and research, and an overview of the literature","volume":"157","author":"Siffel","year":"2011","journal-title":"Am J Med Genet C Semin Med Genet"},{"key":"R29-20260311","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.jpedsurg.2013.11.031","article-title":"The management of bladder exstrophy: The Manchester experience","volume":"49","author":"Dickson","year":"2014","journal-title":"J Pediatr Surg"},{"key":"R30-20260311","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.jpurol.2007.08.003","article-title":"The modern staged repair of bladder exstrophy in the female: A contemporary series","volume":"4","author":"Purves","year":"2008","journal-title":"J Pediatr Urol"},{"key":"R31-20260311","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.urology.2023.08.034","article-title":"Classic bladder exstrophy closure without osteotomy or immobilization: An exercise in futility?","volume":"181","author":"Haffar","year":"2023","journal-title":"Urology"},{"key":"R32-20260311","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.2106\/JBJS.ST.18.00018","article-title":"Bilateral anterior innominate osteotomy for bladder exstrophy","volume":"9","author":"Nhan","year":"2019","journal-title":"JBJS Essent Surg Tech"},{"key":"R33-20260311","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1016\/S0090-4295(03)00791-X","article-title":"Pelvic and extremity immobilization after bladder exstrophy closure:complications and impact on success","volume":"62","author":"Meldrum","year":"2003","journal-title":"Urology"},{"key":"R34-20260311","doi-asserted-by":"crossref","first-page":"430.e1","DOI":"10.1016\/j.jpurol.2018.04.025","article-title":"Predictors and outcomes of perioperative blood transfusions in Bladder Exstrophy Epispadias Complex repair: A single institution study","volume":"14","author":"Maruf","year":"2018","journal-title":"J Pediatr Urol"},{"key":"R35-20260311","doi-asserted-by":"crossref","first-page":"4.e1","DOI":"10.1016\/j.jpurol.2015.07.010","article-title":"Newborn exstrophy closure without osteotomy: Is there a role?","volume":"12","author":"Inouye","year":"2016","journal-title":"J Pediatr Urol"},{"key":"R36-20260311","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.jpedsurg.2021.12.017","article-title":"Delayed primary closure of bladder exstrophy without osteotomy:12 year experience in a safe and gentle alternative to neonatal surgery","volume":"57","author":"Hofmann","year":"2022","journal-title":"J Pediatr Surg"},{"key":"R38-20260311","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1016\/S0090-4295(00)01102-X","article-title":"Determinants of continence in the bladder exstrophy population: Predictors of success?","volume":"57","author":"Chan","year":"2001","journal-title":"Urology"},{"key":"R39-20260311","first-page":"7.e1","article-title":"A critical appraisal of continence in bladder exstrophy: Long-term outcomes of the complete primary repair","volume":"12","author":"Ellison","year":"2016","journal-title":"J Pediatr Urol"},{"key":"R40-20260311","doi-asserted-by":"crossref","first-page":"564.e1","DOI":"10.1016\/j.jpurol.2023.05.005","article-title":"Bladder capacity and growth in classic bladder exstrophy: A novel predictive tool","volume":"19","author":"Maruf","year":"2023","journal-title":"J Pediatr Urol"},{"key":"R41-20260311","doi-asserted-by":"crossref","first-page":"563.e1","DOI":"10.1016\/j.jpurol.2023.04.039","article-title":"Achieving goal capacity for continence surgery: A cumulative event analysis of bladder exstrophy patients","volume":"19","author":"Khandge","year":"2023","journal-title":"J Pediatr Urol"},{"key":"R42-20260311","doi-asserted-by":"crossref","first-page":"427.e1","DOI":"10.1016\/j.jpurol.2018.03.023","article-title":"The inadequate bladder template: Its effect on outcomes in Bladder Exstrophy Epispadias Complex","volume":"14","author":"Di Carlo","year":"2018","journal-title":"J Pediatr Urol"}],"container-title":["Journal of Indian Association of Pediatric Surgeons"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jiaps.jiaps_339_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:36:29Z","timestamp":1787067389000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jiaps.jiaps_339_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,16]]},"references-count":40,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/jiaps.jiaps_339_25","relation":{},"ISSN":["0971-9261","1998-3891"],"issn-type":[{"value":"0971-9261","type":"print"},{"value":"1998-3891","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,16]]},"assertion":[{"value":"2025-09-27","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-27","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}