Failed Primary Bladder Exstrophy Closure with Osteotomy: Multivariable Analysis of a 25-Year Experience

Area of Science:

• Pediatric Surgery
• Orthopedic Surgery
• Urology

Background:

• Primary bladder exstrophy closure aims for functional closure and urinary continence.
• Osteotomy has improved success rates in primary bladder exstrophy closure.
• Despite advancements, primary closure failures still occur, necessitating identification of contributing factors.

Purpose of the Study:

• To identify factors predicting failure in primary bladder exstrophy closure utilizing osteotomy.
• To analyze patient data to determine predictors of unsuccessful primary closure outcomes.

Main Methods:

• A review of 156 classic bladder exstrophy cases primarily closed with osteotomy (1990-2015).
• Data collected included patient demographics, closure details, osteotomy specifics, immobilization, orthopedic management, and pain control.
• Univariate and multivariable analyses were performed to identify failure predictors.

Main Results:

• The overall failure rate for primary closure with osteotomy was 30%.
• Factors significantly reducing failure odds included modified Buck traction and immobilization exceeding 4 weeks.
• Osteotomy performed by general orthopedic surgeons was associated with significantly higher failure odds (OR 23.47).

Conclusions:

• Optimal immobilization strategies, including modified Buck traction and external fixation, are vital.
• Immobilization duration greater than 4 weeks is a critical factor for success.
• Performing osteotomy with pediatric orthopedic surgeons significantly improves outcomes for primary bladder exstrophy closure.