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Published on: January 7, 2019
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Long-Term Orthopaedic and Radiological Outcomes of Symphysis Approximation without Osteotomy in Primary Bladder
Martin Promm1, Raphael Hofbauer2, Roland Brandl3
1Department of Pediatric Urology, St. Hedwig Clinic, University Medical Center of Regensburg, Regensburg, Germany.
Summary
This study found no significant differences in long-term outcomes for bladder exstrophy repair using pubic symphysis approximation without osteotomy, regardless of whether the primary exstrophy repair (PER) was immediate or delayed. These findings support the technique
Area of Science:
- Pediatric Urology
- Orthopedic Surgery
- Developmental Biology
Background:
- Historically, approximation without osteotomy for primary exstrophy repair (PER) was thought suitable only for newborns, with expectations of poorer outcomes.
- Recent evidence suggests this technique offers favorable long-term results even when performed later.
- This study aimed to compare orthopaedic and radiological outcomes of immediate versus delayed PER using symphysis approximation without osteotomy.
Purpose of the Study:
- To evaluate and compare long-term orthopaedic and radiological outcomes.
- To assess the efficacy of pubic symphysis approximation without osteotomy in both immediate and delayed primary exstrophy repair (PER).
- To determine if the timing of PER impacts functional and structural results.
Main Methods:
- Twenty-nine patients with PER undergoing symphysis approximation without osteotomy were recruited between March 2018 and December 2020.
- Exclusion criteria included patients under 12 years and those with prior pelvic orthopaedic surgery.
- Orthopaedic examinations and pelvic MRI were conducted to evaluate pubic diastasis, acetabular angle (ACA), and center-edge angle (CEA).
Main Results:
- No significant differences were observed between immediate and delayed PER groups regarding hip pain, mobility, sports impairment, hip impingement, or leg length discrepancy.
- Magnetic resonance imaging (MRI) showed no significant difference in pubic diastasis width between the groups.
- Radiological parameters, including center-edge angle (CEA) and acetabular angle (ACA) for both hips, showed no statistically significant variations between the immediate and delayed PER groups.
Conclusions:
- Immediate and delayed primary exstrophy repair (PER) using symphysis approximation without osteotomy yield comparable long-term clinical orthopaedic and radiological outcomes.
- The timing of the procedure does not appear to negatively affect functional or structural results.
- Establishing standardized core outcome sets is crucial for robust and comparable research in this field.
