Complications after primary bladder exstrophy closure – role of pelvic osteotomy

摘要

Introduction. Bladder exstrophy is the most common form of the exstrophy – epispadias complex. It isobserved in 1:30 000 life births, about four times more often in boys than in girls. Iliac osteotomy is used tofacilitate bringing together pubic bones and to minimize the tension of fused elements. To analyze complicationsafter primary bladder exstrophy closure with a special consideration of the role of pelvic osteotomy.Material and method. It is a retrospective study evaluating 100 patients (chosen by chance out of 356) withbladder exstrophy (65 boys and 35 girls), treated in Pediatric Urology Department of the Children’s MemorialHealth Institute in Warsaw, Poland between 1982 and 2006. All children underwent primary bladder exstrophyclosure, among them 32 elsewhere. Primary bladder exstrophy closure with contemporary iliac osteotomywas done in 36 children. In the rest 64 patients bladder was closed without osteotomy, regardless child’s age.Results. Dehiscence after primary closure followed with bladder prolaps occurred in 31 patients, amongthem 13 out of 68 (19%) operated in our department and 18 out of 32 (56%) operated in another hospital.Primary bladder exstrophy closure with contemporary iliac osteotomy was done in 32 infants above72 hours of life.Conclusions. Osteotomy performed at primary bladder exstrophy closure diminishes the risk of wounddehiscence independently of patient’s age. Posterior iliac osteotomy is sufficient and safe and could berepeated if necessary