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Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Complications after primary bladder exstrophy closure - role of pelvic osteotomy
Małgorzata Baka-Ostrowska1, Kinga Kowalczyk1, Karina Felberg1
1Department of Pediatric Urology of the Children's Memorial Health Institute, Warsaw, Poland.
Insights
Pelvic osteotomy during bladder exstrophy repair significantly reduces wound complications like dehiscence and prolapse. This surgical technique is effective regardless of patient age and can be safely repeated if needed.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Congenital Abnormalities
Background:
- Bladder exstrophy is a rare congenital condition, part of the exstrophy-epispadias complex, affecting approximately 1 in 30,000 live births.
- It occurs four times more frequently in males than females.
- Iliac osteotomy is a surgical procedure employed to aid in the approximation of pubic bones and reduce tension during closure.
Purpose of the Study:
- To investigate complications following primary bladder exstrophy closure.
- To specifically evaluate the impact and role of pelvic osteotomy in reducing these complications.
Main Methods:
- A retrospective study of 100 patients diagnosed with bladder exstrophy between 1982 and 2006.
- Patients were treated at the Children's Memorial Health Institute, Warsaw, Poland.
- Comparison between primary closure with and without iliac osteotomy, and outcomes based on surgical location.
Main Results:
- Wound dehiscence and bladder prolapse occurred in 31 patients.
- Patients operated elsewhere had a significantly higher rate of dehiscence (56%) compared to those operated at the institute (19%).
- Primary closure with iliac osteotomy was performed in 32 infants within the first 72 hours of life.
Conclusions:
- Performing osteotomy during primary bladder exstrophy closure decreases the risk of wound dehiscence.
- The benefit of osteotomy is independent of the patient's age.
- Posterior iliac osteotomy is a safe and sufficient procedure, with the possibility of repetition if necessary.
Introduction:
Bladder exstrophy is the most common form of the exstrophy - epispadias complex. It is observed in 1:30 000 life births, about four times more often in boys than in girls. Iliac osteotomy is used to facilitate bringing together pubic bones and to minimize the tension of fused elements. To analyze complications after primary bladder exstrophy closure with a special consideration of the role of pelvic osteotomy.
Material And Method:
It is a retrospective study evaluating 100 patients (chosen by chance out of 356) with bladder exstrophy (65 boys and 35 girls), treated in Pediatric Urology Department of the Children's Memorial Health Institute in Warsaw, Poland between 1982 and 2006. All children underwent primary bladder exstrophy closure, among them 32 elsewhere. Primary bladder exstrophy closure with contemporary iliac osteotomy was done in 36 children. In the rest 64 patients bladder was closed without osteotomy, regardless child's age.
Results:
Dehiscence after primary closure followed with bladder prolaps occurred in 31 patients, among them 13 out of 68 (19%) operated in our department and 18 out of 32 (56%) operated in another hospital. Primary bladder exstrophy closure with contemporary iliac osteotomy was done in 32 infants above 72 hours of life.
Conclusions:
Osteotomy performed at primary bladder exstrophy closure diminishes the risk of wound dehiscence independently of patient's age. Posterior iliac osteotomy is sufficient and safe and could be repeated if necessary.
