Horizontal pelvic osteotomies for bladder exstrophy. A preliminary report

Abstract

We have treated 11 patients aged three days to 15 years with bladder exstrophy by horizontal osteotomies of the innominate bones. The operation was originally used for older patients with severe deformity or failed previous surgery but is now applied as a primary procedure in the first week of life. The osteotomies enable the complex malformations to be corrected in a single operation without turning the patient: the pubic bones can be brought together, the abdominal wall repaired and the bladder closed with reconstruction of the urethra and external genitalia. The early results have been very satisfactory in all cases with only minor complications; we felt that a preliminary report should be made, despite a mean follow-up of only seven months.

Orthopedic aspects of separation

“…[3][4][5] The transverse osteotomy is from the sciatic notch to the anterior inferior iliac spine and undertaken with the patient supine. 6,7 The only case of ischiopagus tetrapus in our series had an associated bladder exstrophy. I was unable to find another such case reported in the literature.…”

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

“…Osteotomy had been performed soon after birth, simultaneously to primary bladder closure in five patients, whereas 2 months (n = 1) and 1 year (n = 2) after failure of an attempt to primary closure in the remainders. The type of osteotomy was ischio-pubic [7] in two, posterior vertical iliac [8] in three, and anterior and horizontal [9] in the remaining three treated at our institution.…”

Treatment of Bladder Exstrophy and Epispadias

“…In our hands, Salter-type osteotomies have resulted in temporary femoral nerve palsy in the majority of cases. Still, this technique provides optimal reconstruction of the bony defects [8, 10,11,19,28,29].…”