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Bladder exstrophy and anterior pelvic osteotomy
S Perović1, R Brdar, D Scepanović
1Department of Paediatric Surgery and Urology, University Children's Hospital, Belgrade, Yugoslavia.
Insights
This study demonstrates that primary bladder reconstruction for bladder exstrophy is feasible in children, even those with prior unsuccessful treatments. Surgical techniques involving pubic bone osteotomy and bladder plate management lead to successful outcomes and reconstructible bladders.
Area of Science:
- Pediatric Urology
- Surgical Reconstruction
- Congenital Abnormalities
Background:
- Bladder exstrophy presents significant reconstructive challenges.
- Previous treatments may have been unsuccessful, necessitating further intervention.
- A reliable primary reconstruction method is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the efficacy of a specific surgical technique for primary bladder reconstruction in children with bladder exstrophy.
- To assess the long-term functional outcomes and reconstructibility of the bladder.
Main Methods:
- Surgical reconstruction involving bilateral osteotomy of the superior ramus of the pubic bone.
- Techniques adapted for infants (ischiopubic junction articulation) and older children (inferior ramus fracture).
- Management of the exstrophic bladder plate through pelvic insertion for epithelialization and growth.
Main Results:
- Successful primary bladder reconstruction achieved in 36 children over a 3.5-year follow-up.
- Achieved bladder capacities ranged from 40 to 150 ml.
- Reconstruction remained uncompromised in most patients despite pubic bone diastasis, indicating robust surgical outcomes.
Conclusions:
- Primary bladder reconstruction for bladder exstrophy is a viable and effective procedure.
- The described surgical approach facilitates bladder reconstruction and growth, particularly in older children.
- All cases of exstrophy are amenable to reconstruction using these methods.
Abstract:
Between August 1988 and December 1991, 36 children with bladder exstrophy underwent surgery for primary bladder reconstruction. Each child was either untreated or had already been treated unsuccessfully. The operative technique involved bilateral osteotomy of the superior ramus of the pubic bone. In infants the cartilaginous ischiopubic junction, acting as an articulation, allowed symphyseal approximation, while in older children this was achieved by fracture of the inferior ramus of the pubic bone. The bladder was either closed or, in most cases, the exstrophic bladder plate was inserted deep into the pelvis, allowing subsequent epithelialisation of the bladder and further formation and growth. Follow-up up for 3.5 years showed bladder capacities of 40 to 150 ml. Some patients underwent an additional augmentation enterocystoplasty. Primary bladder reconstruction remained uncompromised in 7 patients who developed moderate (and 1 complete) rediastasis of the pubic bones. All exstrophic bladders are reconstructible, particularly in older children.