Failed Primary Bladder Exstrophy Closure with Osteotomy: Multivariable Analysis of a 25-Year Experience

Sirisreetreerux, Pokket; Lue, Kathy; Ingviya, Thammasin; Friedlander, Daniel; Carlo, Heather N. Di; Sponseller, Paul D.; Gearhart, John P.

doi:10.1016/j.juro.2016.09.114

Cited by 25 publications

(5 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…5 The obstruction at the urethra or bladder neck presents an immediate danger to the upper urinary tract, leads to urinary tract infections, and is difficult to definitively treat. 16 One girl developed this complication, and upper urinary tract dilation was documented. This child is undergoing clean intermittent catheterization and close follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…The etiology of this complication is unclear, but aggressive tailoring at the bladder neck, whether during a CPRE or staged approach or a compartment syndrome effect causing vascular compromise in the deep pelvis after complete reapproximation of the pubic symphysis after osteotomies, are potential factors . The obstruction at the urethra or bladder neck presents an immediate danger to the upper urinary tract, leads to urinary tract infections, and is difficult to definitively treat . One girl developed this complication, and upper urinary tract dilation was documented.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A Model for Sustained Collaboration to Address the Unmet Global Burden of Bladder Exstrophy-Epispadias Complex and Penopubic Epispadias

et al. 2018

View full text Add to dashboard Cite

A unique surgical mission model consisting of an international collaborative focused on treating the complex diagnoses of BE and PE offers outcomes comparable with those in high-income countries, demonstrating a significant patient retention rate and an opportunity to rigorously study outcomes over an accelerated interval owing to the high burden of disease in India. Postoperative care following a systematized algorithm and rigorous follow-up is mandatory to ensure safety and optimal outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Model for Sustained Collaboration to Address the Unmet Global Burden of Bladder Exstrophy-Epispadias Complex and Penopubic Epispadias

et al. 2018

View full text Add to dashboard Cite

show abstract

“…However, osteotomy was required as pelvic bone malleability markedly decreased afterward [ 18 ]. Previous studies concluded that closure of the bladder without pelvic osteotomy showed a higher incidence of premature hip arthrosis, but when combined bladder closure and pelvic osteotomy, it increased the odds of a successful outcome [ 10 , 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

A long-term outcome (up to 29 years) of bilateral iliac wings “bayonet osteotomies” for closure of bladder exstrophy

et al. 2023

View full text Add to dashboard Cite

Background Several types of pelvic osteotomy techniques have been reported and employed by orthopedic surgeons to enhance the approximation of symphyseal diastasis in bladder exstrophy patients. However, there is limited evidence on a long-term follow-up to confirm which osteotomy techniques provide the most suitable and effective outcomes for correcting pelvic deformities. This study aimed to describe the surgical technique of bilateral iliac bayonet osteotomies for correcting pelvic bone without using fixation in bladder exstrophy and to report on the long-term clinical and radiographic outcomes following the bayonet osteotomies. Methods We retrospectively reviewed patients with bladder exstrophy who underwent bilateral iliac bayonet osteotomies with the closure of bladder exstrophy between 1993 and 2022. Clinical outcomes and radiographic pubic symphyseal diastasis measurements were evaluated. From a total of 28 operated cases, eleven were able to attend a special follow-up clinic or were interviewed by telephone by one of the authors with completed charts and recorded data. Results A total of 11 patients (9 female and 2 male) with an average age at operation of 9.14 ± 11.57 months. The average followed-up time was 14.67 ± 9.24 years (0.75–29), with the average modified Harris Hip score being 90.45 ± 1.21. All patients demonstrated decreased pubic symphyseal diastasis distance (2.05 ± 1.13 cm) compared to preoperative (4.58 ± 1.37 cm) without any evidence of nonunion. At the latest follow-up, the average foot progression angle was externally rotated 6.25° ± 4.79° with full hips ROM, and no patients reported abnormal gait, hip pain, limping, or leg length discrepancy. Conclusions Bilateral iliac wings bayonet osteotomies technique demonstrated a safe and successful pubic symphyseal diastasis closure with an improvement both clinically and radiographically. Moreover, it showed good long-term results and excellent patient’s reported outcome scores. Therefore, it would be another effective option for pelvic osteotomy in treating bladder exstrophy patients.

show abstract

“…3 This is of particular importance during surgical reconstruction in those undergoing delayed primary closure or repeat closure for prior failed closure. [4][5][6][7] Postoperative immobilization of the pelvis and lower extremities is essential after pelvic osteotomy in instances when no internal fixation is utilized. Various postoperative immobilization methods have been described, including Bryant traction, spica cast immobilization, and external fixation with Buck's traction.…”

mentioning

confidence: 99%

“…Pelvic osteotomies aim to reduce tension during surgical reconstruction, thereby decreasing the risk of dehiscence and vesicocutaneous fistula 3 . This is of particular importance during surgical reconstruction in those undergoing delayed primary closure or repeat closure for prior failed closure 4–7 …”

mentioning

confidence: 99%

Is Immobilization Technique Associated With Postoperative Pubic Rami Diastasis Following Bladder Exstrophy Closure?

Annabell,

Lee,

Barnett

et al. 2024

Journal of Pediatric Orthopaedics

View full text Add to dashboard Cite

Objective: Pelvic osteotomies relieve tension of the bladder and fascial closures during bladder exstrophy repair. Multiple techniques for postoperative immobilization of the pelvis and lower extremities have been described. The primary aim of this study was to assess differences in short and long-term changes in pubic rami diastasis when comparing Bryant traction to spica cast immobilization. Secondary aims included a comparison of length of stay, skin-related complications, and urologic outcomes. Methods: We performed a single-institutional retrospective review of bladder exstrophy patients younger than 18 months of age who underwent posterior pelvic osteotomy and bladder exstrophy closure from April 2005 to April 2020. Short-term and long-term pubic rami diastasis were defined as postoperative measurements ≤6 months and ≥12 months, respectively. Secondary outcomes included length of stay, pressure ulcer, skin rash/abrasion, urethrocutaneous fistula, and bladder or fascial dehiscence rates. Multivariable logistic regression assessed for an association between immobilization type and degree of diastasis while controlling for age at the time of diastasis measurement and sex. Results: Fifteen patients underwent Bryant traction and 36 patients underwent spica cast immobilization. In both the short-term and long-term, there was a greater reduction in pubic diastasis in the spica cast group (P= 0.002 and P= 0.05, respectively). After adjustments, there were higher odds of having a greater reduction in pubic rami diastasis in both the short-term (odds ratio: 2.71, 95% CI: 1.52-4.86, P= 0.001) and long-term (odds ratio: 2.41, 95% CI: 1.00-5.80, P= 0.05). Length of stay was significantly higher in Bryant’s traction group (26 vs 19 d, P< 0.001). Rates of pressure ulcers were higher in the Bryant traction group (26.7% vs 0%, P= 0.005). Rates of skin rash/abrasions, urethrocutaneous fistula, and bladder/fascial dehiscence did not differ. Conclusions: Spica cast immobilization is a safe and effective immobilization method. Compared with Bryant traction, spica cast immobilization was associated with a greater reduction in postoperative pubic diastasis both short and long-term, along with a shorter length of hospitalization and reduced rate of pressure ulcers. Level of Evidence: Level III—therapeutic study.

show abstract

Failed Primary Bladder Exstrophy Closure with Osteotomy: Multivariable Analysis of a 25-Year Experience

Abstract: Proper immobilization with modified Buck traction and external fixation, immobilization time greater than 4 weeks and undergoing osteotomy performed by a pediatric orthopedic surgeon are crucial factors for successful primary closure with osteotomy.

Cited by 25 publications

References 19 publications

A Model for Sustained Collaboration to Address the Unmet Global Burden of Bladder Exstrophy-Epispadias Complex and Penopubic Epispadias

A Model for Sustained Collaboration to Address the Unmet Global Burden of Bladder Exstrophy-Epispadias Complex and Penopubic Epispadias

A long-term outcome (up to 29 years) of bilateral iliac wings “bayonet osteotomies” for closure of bladder exstrophy

Is Immobilization Technique Associated With Postoperative Pubic Rami Diastasis Following Bladder Exstrophy Closure?

Contact Info

Product

Resources

About