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Newborn exstrophy closure without osteotomy: Is there a role?

Brian M Inouye1, Kathy Lue1, Mahmoud Abdelwahab1

  • 1The Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA.

Journal of Pediatric Urology
|September 24, 2015
PubMed
Summary

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Classic bladder exstrophy (CBE) closure without osteotomy is effective in select newborns. Success rates for closure and bladder capacity for reconstruction were similar between groups, regardless of osteotomy use.

Area of Science:

  • Pediatric Urology
  • Orthopedic Surgery
  • Neonatal Surgery

Background:

  • Classic bladder exstrophy (CBE) closure without osteotomy is increasingly documented.
  • Osteotomy is often required for large bladder templates, significant pubic diastasis, or non-malleable pelvis.

Purpose of the Study:

  • To evaluate indications and outcomes of bladder closure with and without pelvic osteotomy in infants under one month old.
  • To compare success rates and functional outcomes between closure methods.

Main Methods:

  • Retrospective review of 100 classic bladder exstrophy patients under one month old undergoing primary closure.
  • Comparison of outcomes (failure rates, bladder capacity for bladder neck reconstruction) between osteotomy and non-osteotomy groups using chi-square tests.
Keywords:
Classic bladder exstrophyPelvic osteotomyPubic symphysis diastasis

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Main Results:

  • Failure rates were statistically equivalent (10.5% with osteotomy vs. 6.5% without, p=0.466).
  • Sufficient bladder capacity for bladder neck reconstruction was achieved in 82% of the osteotomy group and 71% of the non-osteotomy group (p=0.234).
  • No statistically significant differences in closure success or capacity for BNR between groups.

Conclusions:

  • Newborn CBE closure without pelvic osteotomy is viable for carefully selected patients.
  • Successful primary closure, irrespective of osteotomy, is the key predictor of eventual continence.
  • A multidisciplinary approach is crucial for managing complex exstrophy cases; osteotomy is recommended if pubic diastasis, pelvic malleability, or apposition is uncertain.