A novel technique for approximation of the symphysis pubis in bladder exstrophy without pelvic osteotomy

We evaluated the outcome of pubic bone approximation and internal fixation using a miniature metal plate and screws without osteotomy in children with bladder exstrophy.

A total of 17 children with bladder exstrophy underwent surgery. Mean patient age was 27 months. Of the patients 15 had a history of 1 or more failed bladder closures with or without osteotomy. All children underwent bladder closure and complete posterior and anterior urethroplasty with bladder neck wrap. Both ureteral orifices were brought together by the Gil-Vernet antireflux procedure. The pubes were brought together with 3 deeply placed 1 mm polyglactin sutures through the bone and fixed by placing a miniature metal plate with 6 to 7 screws. Patients remained in a frog leg bandage for 1 to 3 weeks. The plate was removed during additional surgery. Median followup was 61 months (range 14 to 71).

All children had an uneventful postoperative period without any serious complications, except for skin erosion caused by a screw without bone infection in 1 patient, and miniature plate subluxation following cystoscopy for reinsertion of urethral catheter 3 days after initial surgery in 1. Operating time and hospital stay were significantly lower than in children undergoing osteotomy or Bryant's traction. Overall continence rate was 53.8%.

Although the number of patients is low, these results are promising. Pubic bone adaptation with miniature plate fixation without any type of osteotomy or leg traction is safe and less invasive than bilateral osteotomy and postoperative leg traction or plaster.