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Oblique pelvic osteotomy in the exstrophy/epispadias complex.
D Jones1, S Parkinson, H S Hosalkar
1Department of Orthopaedic Surgery, Great Ormond Street Hospital for Children, 5th Floor, Southwood Building, Great Ormond Street, London WC1N, 3JH, UK. JonesD2@gosh.nhs.uk
Summary
Bilateral oblique pelvic osteotomy effectively manages bladder exstrophy complications. This surgical approach, with or without external fixation, shows good functional outcomes and pain relief in patients.
Area of Science:
- Urology
- Pediatric Surgery
- Orthopedic Surgery
Background:
- Bladder exstrophy is a complex congenital anomaly requiring specialized surgical management.
- Pelvic osteotomy is a key component in reconstructive surgery for bladder exstrophy.
- Optimizing pelvic alignment is crucial for successful genitourinary repair and long-term function.
Purpose of the Study:
- To evaluate the efficacy of bilateral oblique pelvic osteotomy in conjunction with genitourinary repair for bladder exstrophy.
- To assess the functional outcomes, pain levels, and complications associated with this surgical technique.
- To analyze the degree of pubic approximation achieved and its correlation with patient age and fixation methods.
Main Methods:
- Retrospective review of 45 patients (46 procedures) with bladder exstrophy treated with bilateral oblique pelvic osteotomy and genitourinary repair.
- Description of operative techniques and post-operative management, including the use of external fixation.
- Follow-up assessment through a dedicated clinic and telephone interviews, with radiographic measurement of pubic approximation.
Main Results:
- A high percentage of patients (42/45) reported no pain or functional disability post-operatively.
- Minor complications included infection and external fixator loosening, managed without significant long-term sequelae.
- Mean pubic approximation was 37%, with variations influenced by patient age and the use of external fixation.
Conclusions:
- Bilateral oblique pelvic osteotomy is a valuable surgical option for managing challenging bladder exstrophy cases, including primary closure failures and secondary reconstructions.
- The technique, particularly with external fixation, aids in achieving adequate pubic approximation, contributing to favorable functional outcomes.
- While effective, the natural development of the anterior segment remains a consideration in the long-term management of bladder exstrophy.