Benz K, et al. - Causes of re-augmentation in patients with classic bladder exstrophy were determined herein. According to findings, the need for bladder re-augmentation was realized most commonly in the setting of a small bladder capacity after an initial AC, when an insufficient amount of bowel was used during the first AC procedure.

• Researchers reviewed a prospectively-maintained institutional database of 1327 exstrophy-epispadias complex patients for CBE patients who had undergone more than one AC procedure.
• They assessed data regarding bladder capacities, complications following AC, and reasons for re-augmentation.

• Data showed that a total of 166 CBE patients underwent AC, of those, 67 (40.4%) were included in the control group and 17 (10%) patients underwent a re-augmentation.
• The presence of following indicated need for re-augmentation: continued small bladder capacity (17/17), inadequate bladder necks (8/17), failed rattail augmentation (2/17), stomal incontinence (1/17), a urethrocutaneous fistula (1/17), and an hourglass augmentation (1/17).
• A re-augmentation procedure with a ureteral reimplantation was performed on 5 (29%) of the 17 patients.
• Researchers noted that in the failed initial AC (8 patients), the sigmoid colon was the most commonly used bowel segment, while the ileum was the most commonly used segment during re-augmentation (12 patients).
• During the first AC procedure in the re-augmentation cohort, the mean amount of bowel used was 12 cm [SD 3.6] compared to 19 cm [SD 5.0] during re-augmentation.
• For control group augmentations, the mean amount of bowel used was 20.8 cm [SD 4].
• The mean re-augmentation pre-operative bladder capacity of 100 mL [SD 60] immediately increased after re-augmentation to 180.8 mL [SD 56.4] (p=0.0001).