Bilateral Obturator Osteotomy: A Novel Osteotomy for Bladder Exstrophy Closure

Area of Science:

• Pediatric Urology
• Orthopedic Surgery
• Developmental Biology

Background:

• Abdominal and pelvic closure presents significant challenges in initial bladder exstrophy repair.
• Existing methods for pubic approximation can be difficult to achieve in certain cases of bladder exstrophy.

Purpose of the Study:

• To evaluate the feasibility and outcomes of a novel bilateral obturator osteotomy technique.
• To assess the safety and efficacy of this osteotomy as an adjunct for bladder exstrophy closure.

Main Methods:

• Retrospective analysis of prospectively collected data from children undergoing single-stage delayed bladder exstrophy closure with Radical Soft Tissue Mobilization (RSTM) for Bladder Exstrophy Epispadias Complex (BEEC).
• Bilateral obturator osteotomy (division of ilio-pubic and ischio-pubic rami, obturator membrane, and internal obturator muscle) was performed when pubic approximation was not feasible.
• Outcomes assessed included bladder dehiscence rate, neurovascular obturator pedicle injury, infections, gait acquisition, and penile vascular impairment.

Main Results:

• 17 children (29% of total BEEC cases) underwent the procedure; no postoperative bladder dehiscence was observed at 6 months.
• Median follow-up was 34 months with no reported complications, including normal ossification on pelvic X-rays.
• No gait abnormalities or clinical signs of obturator nerve deficiency were noted during follow-up.

Conclusions:

• Bilateral obturator osteotomy is a feasible and effective adjunct for bladder exstrophy closure when pubic approximation is not achievable.
• The technique can be performed by pediatric urologists within the same surgical approach.
• This method obviates the need for an external fixator, simplifying post-operative management.