Classic Bladder Exstrophy Closure Without Osteotomy or Immobilization: An Exercise in Futility?
Ahmad Haffar1, Alexander M Hirsch1, Christian C Morrill1
1Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD.
Urology
|September 11, 2023
Summary
Classic bladder exstrophy closure without osteotomy or immobilization has a high failure rate. These findings highlight the importance of osteotomy and immobilization for successful bladder exstrophy repair.
Area of Science:
- Pediatric Urology
- Reconstructive Surgery
Background:
- Classic bladder exstrophy (CBE) is a complex congenital anomaly requiring surgical correction.
- Historically, surgical techniques for CBE closure have evolved, with varying approaches to pelvic stabilization.
Purpose of the Study:
- To review the outcomes of classic bladder exstrophy closure performed without osteotomy or lower extremity/pelvic immobilization.
- To evaluate the impact of these specific surgical omissions on closure success and patient continence.
Main Methods:
- Retrospective review of a prospectively maintained database of 1487 patients with exstrophy-epispadias complex.
- Identification of 56 closure events in 47 unique patients with CBE who underwent closure without osteotomy or immobilization.
- Analysis of closure success rates, failure causes, and functional outcomes including social and spontaneous voided continence.
Main Results:
- A high failure rate of 80.4% (45/56) was observed for CBE closures performed without osteotomy or immobilization.
- Primary closure failure occurred in 83.7% of cases, and secondary closure failure in 69.2%.
- While 78.7% achieved social continence, only 17.0% achieved spontaneous voided continence, with continent catheterizable channels being the most common method of voiding.
Conclusions:
- The results underscore the critical role of osteotomy and postoperative immobilization in achieving successful primary and secondary exstrophy closures.
- These historical findings remain relevant for contemporary surgeons managing classic bladder exstrophy.
- The omission of osteotomy and immobilization is associated with significantly higher failure rates and lower rates of spontaneous voided continence.
