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Complications after primary bladder exstrophy closure - role of pelvic osteotomy.

Baka-Ostrowska M, Kowalczyk K, Felberg K, Wawer Z - Cent European J Urol (2013)

Bottom Line: It is observed in 1:30 000 life births, about four times more often in boys than in girls.Iliac osteotomy is used to facilitate bringing together pubic bones and to minimize the tension of fused elements.Posterior iliac osteotomy is sufficient and safe and could be repeated if necessary.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Urology of the Children's Memorial Health Institute, Warsaw, Poland.

ABSTRACT

Introduction: Bladder exstrophy is the most common form of the exstrophy - epispadias complex. It is observed in 1:30 000 life births, about four times more often in boys than in girls. Iliac osteotomy is used to facilitate bringing together pubic bones and to minimize the tension of fused elements. To analyze complications after primary bladder exstrophy closure with a special consideration of the role of pelvic osteotomy.

Material and method: It is a retrospective study evaluating 100 patients (chosen by chance out of 356) with bladder exstrophy (65 boys and 35 girls), treated in Pediatric Urology Department of the Children's Memorial Health Institute in Warsaw, Poland between 1982 and 2006. All children underwent primary bladder exstrophy closure, among them 32 elsewhere. Primary bladder exstrophy closure with contemporary iliac osteotomy was done in 36 children. In the rest 64 patients bladder was closed without osteotomy, regardless child's age.

Results: Dehiscence after primary closure followed with bladder prolaps occurred in 31 patients, among them 13 out of 68 (19%) operated in our department and 18 out of 32 (56%) operated in another hospital. Primary bladder exstrophy closure with contemporary iliac osteotomy was done in 32 infants above 72 hours of life.

Conclusions: Osteotomy performed at primary bladder exstrophy closure diminishes the risk of wound dehiscence independently of patient's age. Posterior iliac osteotomy is sufficient and safe and could be repeated if necessary.

No MeSH data available.


Related in: MedlinePlus

A girl (a) and a boy (b) with bladder exstrophy before surgery.
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Figure 0001: A girl (a) and a boy (b) with bladder exstrophy before surgery.

Mentions: Bladder exstrophy is the most common form of the exstrophy–epispadias complex. It is observed in one of every 30,000 live births, occurring about four times more often in boys than in girls. It is a complex defect that affects not only the urinary tract, but also the musculoskeletal, gastrointestinal, and genital systems. Developmental anomalies arise between the 6th and 10th week of gestation as a consequence of cloacal membrane hypertrophy, which prevents migration of the mesoderm between the ectoderm and endoderm [1]. This disrupts the development of the lower part of the abdominal wall with a consequent symphyseal diastasis and extension of the muscles and fascias of the anterior abdominal wall and pelvic diaphragm. Additionally, the anus and vagina are positioned more anteriorly. Extension and rotation of the pubic bones that are the attachment for the cavernosal bodies result in reduction and bending of the penis in boys and total cleft of the clitoris in girls (Fig. 1). Furthermore, the urogenital septum, in the form of two lateral bundles that attach the bladder neck region to the pubic bones, is also cleft. Total dissection of these bundles is necessary to position the bladder deep within the pelvis. The primary closure of bladder exstrophy is fundamental for further functional urethral, penile, and bladder neck reconstruction. It is therefore crucial not only to close the bladder, but also to place it properly in the pelvis. Fusion of the symphysis with reconstruction of all layers of the anterior abdominal wall is the basic element of the surgical procedure (Fig. 2). An iliac osteotomy is used to facilitate bringing together pubic bones and to minimize the tension of the fused elements. It is thought that osteotomy is not necessary in newborns up to 72 hours of life because the pubic bones are elastic enough to be brought together [2, 3]; however, is it the correct approach in such patients?


Complications after primary bladder exstrophy closure - role of pelvic osteotomy.

Baka-Ostrowska M, Kowalczyk K, Felberg K, Wawer Z - Cent European J Urol (2013)

A girl (a) and a boy (b) with bladder exstrophy before surgery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3921855&req=5

Figure 0001: A girl (a) and a boy (b) with bladder exstrophy before surgery.
Mentions: Bladder exstrophy is the most common form of the exstrophy–epispadias complex. It is observed in one of every 30,000 live births, occurring about four times more often in boys than in girls. It is a complex defect that affects not only the urinary tract, but also the musculoskeletal, gastrointestinal, and genital systems. Developmental anomalies arise between the 6th and 10th week of gestation as a consequence of cloacal membrane hypertrophy, which prevents migration of the mesoderm between the ectoderm and endoderm [1]. This disrupts the development of the lower part of the abdominal wall with a consequent symphyseal diastasis and extension of the muscles and fascias of the anterior abdominal wall and pelvic diaphragm. Additionally, the anus and vagina are positioned more anteriorly. Extension and rotation of the pubic bones that are the attachment for the cavernosal bodies result in reduction and bending of the penis in boys and total cleft of the clitoris in girls (Fig. 1). Furthermore, the urogenital septum, in the form of two lateral bundles that attach the bladder neck region to the pubic bones, is also cleft. Total dissection of these bundles is necessary to position the bladder deep within the pelvis. The primary closure of bladder exstrophy is fundamental for further functional urethral, penile, and bladder neck reconstruction. It is therefore crucial not only to close the bladder, but also to place it properly in the pelvis. Fusion of the symphysis with reconstruction of all layers of the anterior abdominal wall is the basic element of the surgical procedure (Fig. 2). An iliac osteotomy is used to facilitate bringing together pubic bones and to minimize the tension of the fused elements. It is thought that osteotomy is not necessary in newborns up to 72 hours of life because the pubic bones are elastic enough to be brought together [2, 3]; however, is it the correct approach in such patients?

Bottom Line: It is observed in 1:30 000 life births, about four times more often in boys than in girls.Iliac osteotomy is used to facilitate bringing together pubic bones and to minimize the tension of fused elements.Posterior iliac osteotomy is sufficient and safe and could be repeated if necessary.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Urology of the Children's Memorial Health Institute, Warsaw, Poland.

ABSTRACT

Introduction: Bladder exstrophy is the most common form of the exstrophy - epispadias complex. It is observed in 1:30 000 life births, about four times more often in boys than in girls. Iliac osteotomy is used to facilitate bringing together pubic bones and to minimize the tension of fused elements. To analyze complications after primary bladder exstrophy closure with a special consideration of the role of pelvic osteotomy.

Material and method: It is a retrospective study evaluating 100 patients (chosen by chance out of 356) with bladder exstrophy (65 boys and 35 girls), treated in Pediatric Urology Department of the Children's Memorial Health Institute in Warsaw, Poland between 1982 and 2006. All children underwent primary bladder exstrophy closure, among them 32 elsewhere. Primary bladder exstrophy closure with contemporary iliac osteotomy was done in 36 children. In the rest 64 patients bladder was closed without osteotomy, regardless child's age.

Results: Dehiscence after primary closure followed with bladder prolaps occurred in 31 patients, among them 13 out of 68 (19%) operated in our department and 18 out of 32 (56%) operated in another hospital. Primary bladder exstrophy closure with contemporary iliac osteotomy was done in 32 infants above 72 hours of life.

Conclusions: Osteotomy performed at primary bladder exstrophy closure diminishes the risk of wound dehiscence independently of patient's age. Posterior iliac osteotomy is sufficient and safe and could be repeated if necessary.

No MeSH data available.


Related in: MedlinePlus