Response to Commentary: Practice Patterns in Classic Bladder Exstrophy: A Global Perspective

The comment to the editor is well taken. The authors agree there is considerable heterogeneity between surgeons given bladder exstrophy is a rare condition and availability of appropriate resources, e.g. pediatric orthopedic surgeons, expert pain management team, trained cadre of nursing staff, may alter the approach taken for management. In regards to experience, even in the United States, the highest volume centers have single digit number of cases on average per year [ [1] Schaeffer A.J. Johnson E.K. Logvinenko T. Graham D.A. Borer J.G. Nelson C.P. Practice patterns and resource utilization for infants with bladder exstrophy: a national perspective. J Urol. 2014; 191: 1381-1388https://doi.org/10.1016/j.juro.2013.11.054 Crossref PubMed Scopus (20) Google Scholar ]. Having a global consortium or having dedicated centers of excellence around the world, not just localized in a few geographic regions, would certainly help us answer questions proposed by the commenter. This would be a herculean effort indeed. Until then, the authors believe the optimal approach is the one familiar to the performing surgeon, best available evidence in the literature, and appropriate resources are available at the surgeon's institution to facilitate successful bladder closure. The authors look forward to revisiting this in the future with hopes more surgeons with interest in this rare malady would contribute to such a global survey.