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EDITORIAL COMMENT

These preliminary data are an excellent beginning to a long-termlongitudinal study of bladder ultrastructure and the development ofcontinence. These authors describe the use of electron microscopy tostudy the bladder ultrastructure in classic bladder exstrophy. Theypresent nice data regarding the ultrastructure, defining it as good,intermediate or poor. The authors looked at newborn exstrophybladders, reclosure bladders at the time of bladder neck repair and

bladders that eventually required augmentation. The major strengthof the article involves the use of fine technology, which in the adultliterature has been proven to correlate with bladder function. How-ever, the weakness of the article involves the lack of longitudinallong-term data regarding the eventual development of continence.The authors acknowledge that this type of longitudinal study will beimmensely important and I would agree. I believe that, while thepresented data propose a tempting speculation that the findingscould be related to continence, it is not an absolute. Some bladderswith good parameters as well as some bladders with poor ultrastruc-ture parameters eventually required bladder augmentation. Thismust be studied further. I would encourage the authors to expandthis study to a multicenter approach, where more patients, directclinical correlation and urodynamic correlation to the parameterscould be assessed.

Bradley KroppDepartment of UrologyUniversity of Oklahoma Health Sciences CenterOklahoma City, Oklahoma

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