The failed bladder closure in cloacal exstrophy: Management and outcomes

Area of Science:

• Pediatric Surgery
• Urology
• Congenital Anomalies

Background:

• Cloacal exstrophy (CE) is a severe form of the Exstrophy-Epispadias Complex (EEC).
• CE presents with an omphalocele, complicating primary bladder and abdominal wall closure.
• Failed primary bladder closure necessitates secondary closure, posing significant surgical challenges.

Purpose of the Study:

• To identify patient and surgical factors predicting successful secondary bladder closure in CE patients.
• To analyze outcomes of secondary bladder closure following failed primary attempts.

Main Methods:

• Retrospective review of a single institution's Exstrophy-Epispadias Complex database (1975-2015).
• Inclusion criteria: CE patients with failed primary bladder closure requiring secondary closure.
• Analysis of patient demographics, surgical techniques, and closure outcomes.

Main Results:

• Twenty-four CE patients met inclusion criteria.
• Secondary closure success rates varied significantly by institution (100% vs. 12.5%).
• Older age at secondary closure, pelvic osteotomy, and Buck's immobilization with external fixation were associated with successful outcomes.

Conclusions:

• Pelvic osteotomy and Buck's immobilization with external fixation are key factors for successful secondary bladder closure in CE.
• While reclosure is possible, it often requires multiple procedures.
• Maximizing efforts for successful primary bladder closure remains paramount in managing CE.