Bilateral posterior pelvic resection osteotomies in patients with exstrophy of the bladder
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J J Gugenheim1, E T Gonzales, D R Roth
1Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston 77030, USA.
Insights
This study presents a modified posterior iliac osteotomy technique for bladder exstrophy repair, showing reduced wound breakdown and comparable continence rates to traditional methods. This surgical modification offers improved outcomes for pediatric patients.
Area of Science:
- Pediatric Surgery
- Orthopedic Surgery
- Urology
Background:
- Bladder exstrophy is a complex congenital anomaly requiring surgical correction.
- Traditional bilateral posterior iliac osteotomies are used to facilitate closure but can be associated with complications.
- Improved surgical techniques are needed to enhance outcomes in bladder exstrophy repair.
Purpose of the Study:
- To describe a modified bilateral posterior iliac osteotomy technique for bladder exstrophy.
- To evaluate the efficacy of this modified technique in terms of anterior closure and wound complications.
- To compare the outcomes of the modified technique with traditional osteotomies and closed reduction.
Main Methods:
- A retrospective review of 31 children undergoing bladder exstrophy repair between 1974 and 1994.
- Procedures included closed reduction, classic bilateral posterior iliac osteotomies, and the modified bilateral posterior resection osteotomies.
- Data collected included dehiscence rates and urinary continence outcomes.
Main Results:
- The modified resection osteotomy technique resulted in significantly less wound dehiscence (1/15) compared to classic osteotomies (5/12).
- Urinary continence rates were comparable between the modified resection osteotomy group (9/15) and the classic osteotomy group (9/12).
- Closed reduction achieved continence in 4/4 patients but had one instance of dehiscence.
Conclusions:
- The modified bilateral posterior resection osteotomy is a valuable surgical modification for bladder exstrophy repair.
- This technique facilitates easier anterior closure and reduces the incidence of wound breakdown.
- The modified approach offers comparable urinary continence rates to traditional methods with improved surgical safety.
Abstract:
This paper describes a modification of bilateral posterior iliac osteotomies for bladder exstrophy, in which a strip of ilium is resected subperiosteally lateral to the sacroiliac joints, allowing easier anterior closure with less breakdown compared with traditional osteotomies. Thirty-one children underwent repair of bladder exstrophy between 1974 and 1994. Orthopaedic procedures included: closed reduction and cast application in the newborn period (four patients), classic bilateral posterior iliac osteotomies (12 patients), and bilateral posterior resection osteotomies (15 patients). Dehiscence occurred after one closed reduction, five classic osteotomies, and one resection osteotomy. Urinary continence was obtained in four patients who underwent closed reduction, nine patients who underwent classic posterior osteotomies, and nine patients who underwent posterior resection osteotomies.