Related Experiment Video
Updated: May 9, 2026
Surgical Management of Meatal Stenosis with Meatoplasty
Published on: November 30, 2010
Primary bladder exstrophy closure in neonates: challenging the traditions
I Mushtaq1, M Garriboli2, N Smeulders1
1Department of Pediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom.
Insights
This study shows that primary bladder exstrophy closure without osteotomy is feasible. Managing patients on the surgical ward with epidural analgesia reduces hospital stays and costs.
Area of Science:
- Pediatric Surgery
- Urology
Background:
- Neonatal bladder exstrophy closure traditionally involves postoperative immobilization and pelvic osteotomy.
- This approach presents challenges in patient management and resource utilization.
Purpose of the Study:
- To evaluate a novel approach to neonatal bladder exstrophy closure that omits postoperative immobilization and pelvic osteotomy.
- To compare the outcomes and cost-effectiveness of different postoperative management strategies.
Main Methods:
- A retrospective review of 74 neonatal bladder exstrophy primary closures between 2007 and 2011.
- Comparison of patients managed on a surgical ward with epidural analgesia versus those in the intensive care unit with muscle paralysis and ventilation.
- Analysis of clinical outcomes including time to feed, length of stay, complications, and redo closures, alongside cost-effectiveness.
Main Results:
- Successful primary closure was achieved in 95% of patients (70/74) without osteotomy.
- Patients managed on the surgical ward (n=48) had significantly shorter lengths of stay (11 vs 18 days, p <0.0001) compared to intensive care unit patients (n=26).
- Ward management resulted in substantially lower median costs ($16,214 vs $42,732, p <0.0001) with similar complication rates (8.3% vs 11.5%, p = 0.609).
Conclusions:
- Primary bladder exstrophy closure without pelvic osteotomy and lower limb immobilization is a feasible and effective surgical option.
- Postoperative care on a surgical ward utilizing epidural analgesia offers a more efficient and cost-effective approach, leading to shorter hospitalizations.
Purpose:
We describe a novel approach to neonatal bladder exstrophy closure that challenges the role of postoperative immobilization and pelvic osteotomy.
Materials And Methods:
We reviewed the primary management of bladder exstrophy at our institutions between 2007 and 2011. In particular we compared postoperative management in the surgical ward using epidural analgesia to muscle paralysis and ventilation in the intensive care unit. Clinical outcome measures were time to full feed, length of stay, postoperative complications and redo closure. Cost-effectiveness was also evaluated using hospital financial data. Data are expressed as median (range). Significance was explored by Fisher exact test and unpaired t-test.
Results:
A total of 74 patients underwent primary closure without osteotomy. Successful closure was achieved in 70 patients (95%). A total of 48 cases (65%) were managed on the ward (group A) and 26 (35%) were transferred to the intensive care unit (group B). The 2 groups were homogeneous for gestational age (median 39 weeks, range 27 to 41) and age at closure (3 days, 1 to 152). Complications requiring surgical treatment were noted in 4 patients (8.3%) in group A and 3 (11.5%) in group B (p = 0.609). Length of stay was significantly shorter for the group managed on the ward (11 vs 18 days, p <0.0001). Median costs were $42,732 for patients admitted to the intensive care unit and $16,214 for those admitted directly to the surgical ward (p <0.0001).
Conclusions:
Primary closure of bladder exstrophy without lower limb immobilization and osteotomy is feasible. Postoperative care on the surgical ward using epidural analgesia results in shorter hospitalization.