Repeat pelvic osteotomy improves the management of failed bladder closure in cloacal exstrophy

The authors evaluated the operative benefits of repeat pelvic osteotomy in patients with cloacal exstrophy (CE) undergoing secondary or tertiary bladder closures.

CE patients undergoing secondary or tertiary closures between 1975 and 2025 were identified. Primary pelvic osteotomy was defined as a patient's first osteotomy. Repeat osteotomy refers to the patient's subsequent osteotomy performed at the time of reclosure. Patient demographics, surgical factors, and outcomes were collected.

Among 35 secondary closures, 19 succeeded while 16 failed. A longer interval between primary and secondary closures (1.72 years vs. 0.64 years, p= 0.0031) as well as primary and repeat osteotomies (4.23 years vs. 0.86 years, p = 0.037) was associated with higher success of secondary closures compared to failure. Primary and repeat osteotomies were significantly associated with secondary closure success while secondary closures without osteotomies had higher failure rates (p= 0.02). For secondary closures, 8 patients did not receive an osteotomy. Regarding the type of osteotomy, combined vertical and transverse anterior innominate osteotomies were associated with higher successes in secondary closures (n = 16, 61.11% vs. n = 1, 11.11%), whereas posterior iliac only osteotomies were more likely to result in failure (n = 5, 27.78% vs. n = 7, 77.78%, p= 0.02). Regarding immobilization techniques, the use of Buck's traction with external fixation for secondary bladder closure resulted in higher success rates, while the use of Spica casting, resulted in higher failure rates (n = 16, 63.16% vs. n = 13, 25%, p= 0.02). Secondary closure success was significantly higher at the authors' institution compared to outside hospitals with (n = 13, 68.42% vs. n = 6, 31.58%, p= 0.0016).

Repeat pelvic osteotomy enhanced secondary closure success in CE patients. Osteotomy techniques using combined vertical and transverse anterior innominate osteotomies, as well as the use of Buck's traction with external fixation, were particularly beneficial. These findings suggest that repeat osteotomy along with appropriate immobilization can enhance surgical outcomes in complex CE management of secondary bladder closures.

Treatment Study.

Level III.