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From 2007 to date, fi ve boys with bladder exstrophy underwent this pre-emptive treatment of inguinal hernia at our institution. None has developed a recurrence after a median (range) follow-up of 29 (5 – 46) months. This approach avoids any manipulation of the inguinal canal, which is an advantage per se, but may be even more important in children with bladder exstrophy given the relatively high risk of hernia recurrence reported [ 1,2 ] . Furthermore, the presence of a pelvic diastasis makes the pelvic dissection of the cord easier than in normal children with a closed pelvic ring. The same procedure can also possibly be performed in children with a congenital inguinal hernia undergoing other procedures that require dissection of the perivesical space, e.g. ureteric re-implantation or ureterocoele repair.

We assessed LUTS at least 12 months after RTx in patients without evidence of lower urinary tract dysfunction (non-urologic) that had been anuric for at least six months before RTx. No bladder recycling was performed before RTx. LUTS were evaluated using a questionnaire. Clinical records were also reviewed. LUTS in anuric patients were compared with those in non-anuric patients. Fourteen anuric patients fulfilled the inclusion criteria. Median age at RTx was 11 (5-21) yr, median duration of anuria before RTx 24 (7-46) months, and median post-RTx follow-up 2.7 (1.9-10.2) yr. Daytime symptoms were exceptional. Nocturia was the most common symptom (10 patients). Only one patient reported symptoms to affect her quality of life. One patient experienced a febrile UTI and none graft failure. LUTS (nocturia) proved unrelated to duration of anuria, length of follow-up, and presence of (nocturnal) polyuria. LUTS were not statistically different in patients anuric and non-anuric before RTx. Non-urologic patients suffer from long-term storage symptoms, particularly nocturia. LUTS, however, do not seem to increase the risks of urinary infections or graft failure and appear to occur irrespective of the presence of anuria before RTx. Bladder recycling before RTx seems unnecessary.