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Closure of bladder exstrophy with a bilateral anterior pubic osteotomy: Revival of an old technique.

Elsayed ER, Alam MN, Sarhan OM, Elsayed D, Eliwa AM, Khalil S - Arab J Urol (2011)

Bottom Line: A prospective study carried out between 2006 and 2009 included 15 patients (13 boys and 2 girls; age range 3-47 months).Of these patients, three had recurrent exstrophy while 10 were operated primarily.It is advantageous in being a rapid procedure, and can be completed by the paediatric urologist.

View Article: PubMed Central - PubMed

Affiliation: Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.

ABSTRACT

Objective: To evaluate the results of simple closure using bilateral anterior pubic osteotomy to achieve a tension-free approximation of the pubis and abdominal wall in patients with bladder exstrophy.

Patients and methods: A prospective study carried out between 2006 and 2009 included 15 patients (13 boys and 2 girls; age range 3-47 months). Of these patients, three had recurrent exstrophy while 10 were operated primarily. An elective surgical technique was used for all patients, which included dissection of the exstrophic bladder from the abdominal wall, closure of the bladder and reconstruction of the urethra, then dissection of the rectus muscle and sheath lateral to the attachment of muscle to pubic bone, which makes osteotomy of the superior pubic ramus easy, thus facilitating closure.

Results: For closure of the bladder and anterior abdominal wall the results were excellent for all patients soon after surgery, but there was soft-tissue infection in two patients. Of all 15 patients, one had incomplete bladder dehiscence and another had a vesico-cutaneous fistula; both needed surgical intervention later.

Conclusions: Simple closure with anterior pubic osteotomy is a feasible and effective means to facilitate both bladder and abdominal closure for patients with bladder exstrophy. It is advantageous in being a rapid procedure, and can be completed by the paediatric urologist.

No MeSH data available.


Related in: MedlinePlus

Easy approximation of the two recti in the midline after osteotomy.
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f0015: Easy approximation of the two recti in the midline after osteotomy.

Mentions: To begin anterior pubic osteotomy, both rectus muscles and sheath are identified and dissection is continued between the rectus sheath and the subcutaneous tissue laterally until the lateral boarder of the rectus abdominis muscle is reached. The rectus sheath is incised at this point and the superior pubic ramus is exposed. The periosteum of the superior pubic ramus is incised at the superior half of the pubic ramus medial to the insertion of the inguinal ligament. A bone retractor is inserted in the obturator foramen below the superior pubic ramus before starting the pubic osteotomy, to protect the obturator nerve and vessels. Pubic osteotomy is then performed using a chisel and mallet (diathermy was sometimes used), with particular care taken not to tear the inferior periosteum or injure the obturator nerve (Fig. 2). After completing the pubic osteotomy bilaterally, both pubic bones are tilted medially and approximated using one or two polyglactin-1 or -2 sutures (Fig. 3). The proposed bladder neck and urethra are positioned deep to the approximated pubic bones before securing the polyglactin sutures. Two drains are inserted at the site of both pubic osteotomy and one more is inserted at the site of the reconstructed bladder. Wound closure is started by approximating both rectus muscles which, after completing the osteotomy, are easily approximated using interrupted absorbable sutures. Finally, the skin is closed, with reconstruction of the umbilicus (Fig. 4). Fig. 5 shows a diagram of the procedure. A hip spica cast was used as fixation in recurrent cases only for 2–3 weeks, while in the other cases simple closure was by a plaster and pressure bandage for 2 weeks. All patients were kept on bed rest during the period of hip spica, and movement was allowed thereafter.


Closure of bladder exstrophy with a bilateral anterior pubic osteotomy: Revival of an old technique.

Elsayed ER, Alam MN, Sarhan OM, Elsayed D, Eliwa AM, Khalil S - Arab J Urol (2011)

Easy approximation of the two recti in the midline after osteotomy.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150575&req=5

f0015: Easy approximation of the two recti in the midline after osteotomy.
Mentions: To begin anterior pubic osteotomy, both rectus muscles and sheath are identified and dissection is continued between the rectus sheath and the subcutaneous tissue laterally until the lateral boarder of the rectus abdominis muscle is reached. The rectus sheath is incised at this point and the superior pubic ramus is exposed. The periosteum of the superior pubic ramus is incised at the superior half of the pubic ramus medial to the insertion of the inguinal ligament. A bone retractor is inserted in the obturator foramen below the superior pubic ramus before starting the pubic osteotomy, to protect the obturator nerve and vessels. Pubic osteotomy is then performed using a chisel and mallet (diathermy was sometimes used), with particular care taken not to tear the inferior periosteum or injure the obturator nerve (Fig. 2). After completing the pubic osteotomy bilaterally, both pubic bones are tilted medially and approximated using one or two polyglactin-1 or -2 sutures (Fig. 3). The proposed bladder neck and urethra are positioned deep to the approximated pubic bones before securing the polyglactin sutures. Two drains are inserted at the site of both pubic osteotomy and one more is inserted at the site of the reconstructed bladder. Wound closure is started by approximating both rectus muscles which, after completing the osteotomy, are easily approximated using interrupted absorbable sutures. Finally, the skin is closed, with reconstruction of the umbilicus (Fig. 4). Fig. 5 shows a diagram of the procedure. A hip spica cast was used as fixation in recurrent cases only for 2–3 weeks, while in the other cases simple closure was by a plaster and pressure bandage for 2 weeks. All patients were kept on bed rest during the period of hip spica, and movement was allowed thereafter.

Bottom Line: A prospective study carried out between 2006 and 2009 included 15 patients (13 boys and 2 girls; age range 3-47 months).Of these patients, three had recurrent exstrophy while 10 were operated primarily.It is advantageous in being a rapid procedure, and can be completed by the paediatric urologist.

View Article: PubMed Central - PubMed

Affiliation: Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.

ABSTRACT

Objective: To evaluate the results of simple closure using bilateral anterior pubic osteotomy to achieve a tension-free approximation of the pubis and abdominal wall in patients with bladder exstrophy.

Patients and methods: A prospective study carried out between 2006 and 2009 included 15 patients (13 boys and 2 girls; age range 3-47 months). Of these patients, three had recurrent exstrophy while 10 were operated primarily. An elective surgical technique was used for all patients, which included dissection of the exstrophic bladder from the abdominal wall, closure of the bladder and reconstruction of the urethra, then dissection of the rectus muscle and sheath lateral to the attachment of muscle to pubic bone, which makes osteotomy of the superior pubic ramus easy, thus facilitating closure.

Results: For closure of the bladder and anterior abdominal wall the results were excellent for all patients soon after surgery, but there was soft-tissue infection in two patients. Of all 15 patients, one had incomplete bladder dehiscence and another had a vesico-cutaneous fistula; both needed surgical intervention later.

Conclusions: Simple closure with anterior pubic osteotomy is a feasible and effective means to facilitate both bladder and abdominal closure for patients with bladder exstrophy. It is advantageous in being a rapid procedure, and can be completed by the paediatric urologist.

No MeSH data available.


Related in: MedlinePlus