Pelvic and extremity immobilization after bladder exstrophy closure: complications and impact on success

Meldrum, Kirstan K.; Baird, Andrew D.; Gearhart, John P.

doi:10.1016/s0090-4295(03)00791-x

Cited by 159 publications

(32 citation statements)

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“…Sponseller et al [15] suggested two possible mechanisms accounting for it, either a partial derotation of the pelvis before the osteotomy site heals or the long-term undergrowth of the ischiopubic segment. Unfortunately, most of our osteotomy patients were secondary referrals, and therefore we could not define the cause of recurrence, which can be related to many factors [17]. Anyway, the similar diastasis between groups suggests that this is not a critical factor for the final outcome as it is also suggested by the three-dimensional magnetic resonance imaging study by Williams et al [5].…”

Section: Discussionmentioning

confidence: 90%

“…It is indeed essential in re-operative closures after previous failures or in case of delayed closures due to either delayed presentation or inadequate bladder template [6,17]. Although Kajbafzadeh et al [22] proposed a modified technique to achieve a secure closure even in these scenarios without osteotomy, the latter remains the best established method to obtain a tension-free closure of abdominal wall and bladder.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2008

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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.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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

et al. 2008

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“…Patients are placed in hip spicas with Bryant or Buck traction depending on the surgery which has been performed. In cases of failed primary closure, a combination of external fixation and 6-8 weeks of Buck traction with osteotomy enabled closure to persist in 96% of these patients (Meldrum et al, 2003). In the same study, one patient suffered a pressure sore secondary to the insertion of a spica cast.…”

Section: Bladder Exstrophymentioning

confidence: 85%

Textbook of Plastic and Reconstructive Surgery

Butler¹,

Ghali²,

Kalaskar³

2016

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A CIP catalogue record for this book is available from The British Library.This book is published under a Creative Commons Attribution Non-commercial Non-derivative 4.0 International license (CC BY-NC-ND 4.0). This license allows you to share, copy, distribute and transmit the work for personal and non-commercial use providing author and publisher attribution is clearly stated. Further details about CC BY licenses are available at http://creativecommons.org/ licenses/by/4.0The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. The user is advised to always check the product information and clinical procedures with the most up-to-date published product information and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or misuse or misapplication of material in this work.ISBN: 978-1-910634-37-0 (Hbk.) ISBN: 978-1-910634-38-7 (Pbk.) ISBN: 978-1-910634-39-4 (PDF) ISBN: 978-1-910634-40-0 (epub) ISBN: 978-1-910634-41-7 (mobi)

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“…Use of routine osteotomy is associated with improved success of primary repair by reducing the tension on the abdominal wall closure that allows for improved healing and deeper placement of the bladder in to the pelvis [57]. Bilateral anterior, transverse innominate, and vertical posterior iliac osteotomies are superior to other types as they decrease the rate of abdominal dehiscence and bladder prolapse [58].…”

Section: Osteotomy and Immobilizationmentioning

confidence: 99%

“…We feel this approach best relieves the tension on the abdominal wall closure, thus preventing dehiscence. Alternatively, a spica cast may be used for immobilization of the pelvis; however, both spica casts and "mummy wrap" immobilization have lower success rates and higher rates of skin breakdown [57].…”

Section: Osteotomy and Immobilizationmentioning

confidence: 99%

Exstrophy-Epispadias Complex

Stuhldreher¹,

Inouye²,

Gearhart³

2015

Curr Bladder Dysfunct Rep

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Bladder exstrophy is a complex congenital birth defect ranging from complete epispadias to complete bladder exstrophy. Though not included in the exstrophy-epispadias complex (EEC) disease spectrum, cloacal exstrophy is a more severe form which includes bowel segments in the defect and has many of the same defects as the EEC. Initial care of these complex patients focuses on the primary repair of the defect, a repair which is the most important of the many operations these children will have in their lifetime. A failure of primary closure is associated with worse outcomes across the board. The most essential goal in treatment of the exstrophy patient is renal protection. Once that can be assured, social continence then becomes the most important goal. Given the complex nature of this disorder, these children should be managed at speciality centers with orthopedic, urologic, and nursing experience with these patients.

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Pelvic and extremity immobilization after bladder exstrophy closure: complications and impact on success

Cited by 159 publications

References 10 publications

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

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

Textbook of Plastic and Reconstructive Surgery

Exstrophy-Epispadias Complex

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