Penile deformity in bladder exstrophy: correlation with closure of pelvic defect

In the exstrophy-epispadias complex of anomalies, penile deformity represents one of the factors that causes long-term disability in males. In order to define the extent to which the separation of the bony elements may contribute to the final penile length and configuration, an in vitro model was devised using an adult male pelvis and an inflatable penile prosthesis. This model was used to study the relationship of interpubic distance to penile length. Closure of the "open book" deformity of the bony pelvis resulted in an increase in penile length. Closure of the pubic diastasis is best accomplished by iliac osteotomies. This study supports clinical evidence that iliac osteotomies, when performed in conjunction with closure of the exstrophic urinary bladder, may contribute to an increase in effective penile length.