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Shortened pubic bones in bladder exstrophy: a congenital or acquired phenomenon?
Linda Stephens1, Alberto Mantovani1, David J B Keene1
1Department of Paediatric Urology, Royal Manchester Children's Hospital, Oxford Road, Manchester M13 9WL, UK.
Insights
Pubic bone length in infants with classic bladder exstrophy is not shorter than in controls. This suggests that pubic bone shortening in bladder exstrophy may be acquired after the first year of life.
Area of Science:
- Pediatric Urology
- Developmental Biology
- Skeletal Dysplasias
Background:
- Classic bladder exstrophy is associated with pelvic abnormalities.
- Previous studies suggest shorter anterior pelvic segment length in bladder exstrophy patients.
- Existing research often includes a wide age range, potentially confounding results.
Purpose of the Study:
- To investigate congenital pubic bone length discrepancies in infants with classic bladder exstrophy.
- To determine if superior pubic ramus length differs between infants with bladder exstrophy and age-matched controls.
- To clarify the origin of pubic bone shortening in bladder exstrophy.
Main Methods:
- Study included 14 infants (<1 year) with classic bladder exstrophy and 14 age-matched controls.
- Three-dimensional (3D) computed tomography (CT) scans were used to measure bilateral superior pubic ramus length.
- Statistical analysis employed the Mann-Whitney U test, with p < 0.05 considered significant.
Main Results:
- No significant difference in median age between the exstrophy (72 days) and control (64 days) groups (p = 0.76).
- Median superior pubic ramus length was 19.1 mm in the exstrophy group and 20 mm in the control group.
- No statistically significant difference in superior pubic ramus length was found between groups (p = 0.99).
Conclusions:
- Infants with classic bladder exstrophy do not exhibit statistically different superior pubic ramus length compared to controls.
- The study hypothesizes that pubic bone shortening in bladder exstrophy is an acquired condition.
- This acquired shortening may develop after the first year of life.
Objective:
It is accepted that the length of the anterior segment of the pelvis in classic bladder exstrophy is shorter than that of controls. However, studies performed involve children with a wide range of ages. By studying children with classic bladder exstrophy under the age of 1 year, the authors aim to ascertain if there is a congenital pubic bone length discrepancy associated with bladder exstrophy.
Material And Methods:
Fourteen classic bladder exstrophy patients under 1 year of age and 14 age-matched controls were identified. Three-dimensional (3D) computerized tomography was used to measure the length of the superior pubic ramus bilaterally. In the exstrophy group, scans were performed before bladder closure. The Mann-Whitney U test was used and p < 0.05 was considered significant.
Results:
There was no significant difference (p = 0.76) in the median age in cases (72 days) and controls (64 days). The median superior pubic ramus length was 19.1 mm in the exstrophy group and 20 mm in the control group (p = 0.99).
Conclusions:
Superior pubic ramus length in children under 1 year of age with classic bladder exstrophy is not statistically different from that in control subjects. Therefore, the authors hypothesize that the previously described shortening of the pubic bones is an acquired phenomenon, which may develop after the first year of life.
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