urovestВестник урологииUrology Herald2308-6424Rostov State Medical University10.21886/2308-6424-2026-14-4-68-77urovest-1260Research ArticleОБЗОРЫ ЛИТЕРАТУРЫREVIEWS ARTICLEСравнение полной первичной реконструкции и современной поэтапной реконструкции при комплексе экстрофии мочевого пузыря и эписпадии: систематический обзор и метаанализComplete primary repair versus modern staged repair for bladder exstrophy-epispadias complex: a systematic review and meta-analysishttps://orcid.org/0009-0006-2112-3028АлханифаА. Ф.AlhanifaA. F.

Азза Фитра Альханифа — бакалавр медицины 

Денпасар 

Azza Fithra Alhanifa — BMedSc 

Denpasar 

fithrau@gmail.comhttps://orcid.org/0009-0002-7024-1507АбхикрамаИ. М. Б.Д.AbhikramaI M. B. D.

И Маде Брамантью Дви Абхикраму — BMedSc 

Денпасар 

I Made Bramantya Dwi Abhikrama — BMedSc 

Denpasar 

iniabhibram@gmail.comhttps://orcid.org/0000-0001-5519-1316ТиртаясаП. М.В.TirtayasaP. M. W.

Панде Маде Вишну Тиртаяса — доктор медицины, доктор философии 

Денпасар 

Pande Made Wisnu Tirtayasa — MD, PhD 

Denpasar 

wisnu.tirtayasa@gmail.comhttps://orcid.org/0000-0002-0642-159XДуарсаГ. В.К.DuarsaG. W. K.

Геде Вирья Кусума Дуарса — доктор медицины, доктор философии 

Денпасар 

Gede Wirya Kusuma Duarsa — MD, PhD  

Denpasar 

gwkduarsa@gmail.comУниверситет УдаянаИндонезияUdayana UniversityIndonesia2026220820261446877Copyright © Алханифа А., Абхикрама И., Тиртаяса П., Дуарса Г., 20262026Алханифа А., Абхикрама И., Тиртаяса П., Дуарса Г.Alhanifa A., Abhikrama I., Tirtayasa P., Duarsa G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.urovest.ru/jour/article/view/1260

Введение. Комплекс экстрофии мочевого пузыря и эписпадии относится к числу наиболее сложных врождённых пороков развития и требует многоэтапного хирургического лечения. В клинической практике основными подходами служат полная первичная реконструкция экстрофии и современная этапная коррекция, однако их сравнительная эффективность до настоящего времени оставалась недостаточно обобщённой.Цель настоящего обзора заключалась в оценке различий между указанными подходами по частоте достижения континенции, хирургическим осложнениям, потребности в повторных вмешательствах и состоянию верхних мочевых путей.Материалы и методы. Поиск литературы проводили в базах PubMed/MEDLINE, Scopus, Europe PMC и Epistemonikos с момента их создания до 1 апреля 2026 года. В обзор включали сравнительные исследования пациентов с классической экстрофией мочевого пузыря либо комплексом экстрофии мочевого пузыря и эписпадии. Отбор публикаций, извлечение данных и оценку риска систематической ошибки по шкале Newcastle-Ottawa выполняли два исследователя независимо друг от друга. Для метаанализа с моделью случайных эффектов рассчитывали отношения рисков с 95% доверительными интервалами.Результаты. В анализ были включены 8 исследований, включавших 878 пациентов. Достоверных различий по общей континенции, спонтанному мочеиспусканию, длительности «сухого» периода и необходимости последующей реконструкции шейки мочевого пузыря не выявлено. Вместе с тем полная первичная реконструкция ассоциировалась с более высокой частотой повторного закрытия мочевого пузыря, общим числом повторных операций и фебрильных инфекций мочевых путей. При этом эффект в отношении повторного закрытия во многом определялся результатами одного исследования из референс-центра и после его исключения утрачивал статистическую значимость. Показатели со стороны верхних мочевых путей в сравниваемых группах были сопоставимы.Заключение. Достоверных различий по континенции не установлено, однако делать вывод об эквивалентности методов преждевременно ввиду недостаточной статистической мощности ряда анализов. По имеющимся данным, полная первичная реконструкция сопровождается более высокой частотой осложнений, связанных с закрытием мочевого пузыря, а также инфекционной морбидностью. Выбор хирургической тактики должен определяться индивидуально с учётом клинической ситуации и опыта специализированного центра.

Introduction. Bladder exstrophy-epispadias complex requires complex surgical repair. Complete primary repair of exstrophy and modern staged repair of exstrophy are the two principal approaches, but their comparative outcomes have not been quantitatively pooled.This review assessed whether complete primary repair differs from staged repair in continence, surgical morbidity, reoperation, and upper urinary tract outcomes.Materials & methods. PubMed / MEDLINE, Scopus, Europe PMC, and Epistemonikos were searched from inception to April 1, 2026. Comparative studies of patients with classic bladder exstrophy or bladder exstrophy-epispadias complex were included. Two authors independently selected studies, extracted data, and assessed risk of bias with the Newcastle-Ottawa Scale. Random-effects meta-analysis generated risk ratios with 95% confidence intervals.Results. Eight studies including 878 patients were analyzed. No significant difference was detected for overall continence, spontaneous voiding, dry interval, or subsequent bladder neck reconstruction. Complete primary repair was associated with higher redo bladder closure, overall reoperation, and febrile urinary tract infection. The redoclosure finding depended on one referral-center study and became non-significant after its exclusion. Upper urinary tract outcomes were comparable.Conclusion. No significant continence difference was detected, but equivalence cannot be inferred because several analyses were underpowered. Complete primary repair carried higher closure-related and infectious morbidity in the available observational evidence. Surgical choice should be individualized according to patient factors and institutional expertise.

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The authors declare that there are no conflicts of interest present.