Pelvic floor anatomy in classic bladder exstrophy using 3-dimensional computerized tomography: initial insights.

Area of Science:

• Urology
• Anatomy
• Pediatric Surgery

Background:

• Classic bladder exstrophy (CBE) is a complex congenital condition affecting pelvic floor anatomy.
• Understanding pelvic floor musculature is crucial for surgical outcomes and long-term functional recovery.

Purpose of the Study:

• To delineate the detailed pelvic floor anatomy, including the levator ani, obturator internus, and obturator externus, in patients with CBE.
• To investigate the relationship between pelvic floor and bony anatomy and the impact of osteotomy on pelvic floor structure to improve urinary control post-surgery.

Main Methods:

• 3D computerized tomography (CT) scans were performed on 7 patients (6 males, 1 female) with CBE, aged 2 months to 8 years.
• Pelvic floor musculature was compared between patients undergoing primary or repeat closure and 26 age- and sex-matched controls.

Main Results:

• Patients with CBE exhibited a significantly wider levator ani area (9.5 cm²), shorter anterior segment (1.2 cm), and longer posterior segment (2.5 cm) compared to controls.
• The levator ani showed increased outward rotation (38.8°), a 2-fold wider transverse diameter of the levator hiatus, and a 1.3-fold longer hiatus.
• Flattening of the puborectal sling (31.7° decrease in steepness) and increased outward rotation of obturator internus (15.1°) and externus (16.9°) were observed in CBE patients.

Conclusions:

• This study reveals significant anatomical differences in the pelvic floor musculature of patients with classic bladder exstrophy.
• These documented variations provide a better understanding of pelvic floor anatomy in CBE.
• Findings may offer new insights into long-term issues like urinary/fecal incontinence and pelvic organ prolapse in CBE patients.