Comparison of musculoskeletal and urological functional outcomes in patients with bladder exstrophy undergoing repair with and without osteotomy

Abstract

It is controversial as to whether osteotomy, by restoring a more normal pelvic anatomy, might improve the final outcome of bladder exstrophy (BE) repairs. We compared the functional orthopaedic and urological outcomes in BE patients treated with and without osteotomy. Orthopaedic and urological outcomes were compared in eight BE patients treated with osteotomy and six BE patients treated without osteotomy. Orthopaedic evaluation included an assessment of pubic bones dissymmetry, bending of the spine, presence of Trendelenburg or Thomas sign, and presence of out-toeing. Pubic diastasis was ruled out on a plain X-ray of the pelvis. A Pediatric Orthopedic Society of North America (POSNA) questionnaire was administered to every child or his/her caregiver to assess functional outcome. Urological evaluation included an assessment of required continence surgeries and of contemporary continence status. All patients presented a pubic diastasis. This was in median 49 (24-66) mm in patients treated without osteotomy and 42 (25-101) mm in those treated with osteotomy (p = 0.3). There was no difference either in the orthopaedic outcome or in any features of the POSNA questionnaire between groups. Neither was there a difference in the final continence rate nor in the number of additional continence procedures required. Although osteotomy is an essential step in the treatment of many BE patients in order to achieve a tension-free closure of the abdominal wall and bladder, our preliminary results suggest that it does not improve the eventual orthopaedic or urological outcomes of BE.

Exstrophy–Epispadias Complex in a Newborn: Case Report and Review of the Literature

“…Although patients with exstrophy have almost invariably an abnormal gait in the long term because of the recurrence of the pelvic diastasis, which invariably recurs also in patients undergoing osteotomy, long-term orthopedic complications are rare. 25 Patients receiving an osteotomy may experience transient of persistent nerve damage, hip pain, and unequal length of limbs. 26 …”

PEDIATRIC UROLOGY Complications after primary bladder exstrophy closure – role of pelvic osteotomy

“…In the past there was an idea to close the symphysis without osteotomy, especially in newborn up to 72 hours [6]. Recently, most authors agree that osteotomy is an essential step in the treatment of bladder exstrophy in order to achieve a tension–free closure of the bladder and abdominal wall [7–9]. Even advocators of the one–stage repair who performed the procedure without osteotomy are presently leaning to osteotomies in most patients [10].…”

“…The pelvic diaphragm is also important for further functional reconstruction and the achievement of the continence [11, 14, 15]. However some authors question the role of osteotomy in ultimate orthopedic and urological outcomes, but the small number of patients being evaluated seems to be inadequate for such conclusions [7, 8]. …”

“…There are two types of iliac osteotomy mostly used: posterior and anterior [2, 7, 8, 12, 16]. However, a group from Baltimore has advocated performing these two procedures together as a combined transverse innominate and vertical iliac osteotomy [9].…”

Aesthetic, urological, orthopaedic and functional outcomes in complex bladder exstrophy-epispadias′s management

“…Postoperative complications of bladder exstrophy management are orthopedic, urological and genital. [ 6 7 ] These complications are related to the surgical procedures, of failures of initial bladder closure. The psychological and-social impact of this condition often requires an evaluation of its effect on the quality of life of parents and children.…”