John D. Gearhart - US grants

Bladder exstrophy, cloacal exstrophy, and epispadias are all variants of the exstrophy-epispadias complex. Although the incidence of this complex is not common, its effects on the child are life-long. Although recently, better ways of managing these conditions have been developed, there is still a need for more basic science research to understand how exstrophic bladder smooth muscle and its matrix components develop in the pre-natal and newborn period and how they can be optimized to yield better functional results. Meanwhile, the surgical reconstructive techniques for patients with this spectrum of conditions continues to be debated within the literature. This conference will bring together major clinical investigators who care for patients born with the exstrophy-epispadias complex as well as scientific investigators who study the morphologic and functional bladder changes seen in this condition as well as in normal bladder development. An international field of 29 speakers (most of whom have been working with the exstrophy-epispadias complex for at least 5 years) will present their work on a particular subtopic in a 15 or 20 minute talk. Subtopics will be clustered together and followed by open panel discussions. We hope to assemble speakers with diverse views to prompt a vigorous exchange of ideas. There will also be an opportunity for young investigators to present their work in a moderated poster session. Presenters will also submit their work for publication in a conference manuscript. This conference will be unique for several reasons. There has never been an international conference of this magnitude which has been dedicated solely to the topic of the exstrophy-epispadias complex. Second, it will combine the expertise of both clinical and laboratory investigators most of whom have spent many years studying the changes in bladder composition and function which occur with this clinical spectrum, and will allow them a format for presenting their most recent findings. Lastly, there will be time for in-depth discussion to insure that everyone will benefit from this experience. Our goal is to not only disseminate important new information, but also to encourage further collaboration between clinicians and basic scientists.

DESCRIPTION (Adapted from applicant's description): Bladder exstrophy, cloacal exstrophy and epispadias are all variants of the exstrophy-epispadias complex. Although this is an uncommon congenital anomaly, its effects on the child and family are life-long. Significant strides have been made in improving the functional and cosmetic results of surgical reconstruction, however an understanding of the embryological development of the anomaly and the resultant changes in the bladder and related organs of the body in this congenital anomaly continue to be elucidated. This Second Symposium will again bring together researchers and surgeons from around the world to share and develop consensus on the latest research efforts in the field as well as showcasing the latest surgical advances. Fifteen to twenty minute talks will be presented by individuals with considerable expertise in the field of exstrophy and epispadias (minimum 5 years of experience in this area). This will be followed by open panel discussions in which audience participation will be permitted. Fielding a panel of speakers with diverse views on the various aspects of research and management will permit a vigorous exchange of ideas. There will also be the opportunity for young researchers in the field to present their continuing work. Presenters will have their material submitted for publication in the conference proceedings. The First Symposium was well attended and the reviews were universally positive. The Proceedings have been published in the form of a text. It is hoped that the continued rapport generated by conferences of this nature will permit greater collaboration between researchers in the field from all parts of the world and further improve the understanding of this complex set of malformations.

DESCRIPTION (provided by applicant): Bladder exstrophy, cloacal exstrophy, and epispadias are all variants of the exstrophyepispadias complex. Although this is an uncommon congenital anomaly, its effects on the child and family are life-long. Over the last 50 years, slow, incremental refinements in the medical and surgical management of these conditions have permitted most children to lead productive lives with good renal outcomes. Yet, while significant gains have been made, the etiology for the development of the complex and the mechanisms that do not permit complete success in all children still remain to be determined. There is still much to be learned in areas of such as incontinence management, detrusor physiology, genital reconstruction, and fertility as they relate to exstrophy, epispadias, and cloacal exstrophy. This symposium intends to concentrate on those areas. The 3rd International Symposium on the Exstrophy - Epispadias Complex is the only academic forum dedicated solely to the exchange of ideas in the management of these conditions and again brings together recognized international experts in the field and allows for their cross talk with junior investigators and young clinicians, setting the stage for continued advancement. Fifteen to twenty minute talks will be presented by individuals with considerable expertise in the field of exstrophy and epispadias. These sessions will then be followed by open panel discussions in which audience participation is permitted. Fielding a panel of speakers with diverse views on the various aspects of research and management will permit a vigorous exchange of ideas. There will also be opportunities for young researchers in the field to present their continuing work. Presenters will have their material submitted for publication in the conference proceedings. Our two previous symposiums were well attended and reviews were universally positive. It is hoped that the continued rapport generated by conferences of this nature will permit greater collaboration between researchers in the field from all parts of the world and further improve our understanding of this complex set of malformations. While bladder exstrophy, epispadias, and cloacal exstrophy doomed children to dismal outcomes fifty years ago, slow, incremental refinements in the medical and surgical management of these conditions have permitted most children to lead productive lives with good renal outcomes. Yet, while significant gains have been made, the etiology for the development of the complex and the mechanisms that do not permit complete success in all children still remain to be determined. The 3rd International Symposium on the Exstrophy - Epispadias Complex is the only academic forum dedicated solely to the exchange of ideas in the management of these conditions and brings together recognized international experts in the field and allows for their cross talk with junior investigators and young clinicians, setting the stage for continued advancement.