Hip Configuration and Function in Bladder Exstrophy Treated Without Pelvic Osteotomy

Bladder exstrophy is an embryologic malformation that affects urogenital and skeletal systems. Non-operative treatment of this rare problem is impossible. Urogenital reconstructions can be facilitated by orthopedic procedures. These reconstructions can be performed in a single stage as a complete repair or multi-stage approaches. The goal of the treatment is closure of the bladder and abdominal wall for the achievement of continence, preservation of renal functions, and cosmetic and functional reconstruction of genital organs. Orthopedic procedures are performed to decrease the tension that complicates the bladder and abdominal wall closure by approximating the pubic rami to achieve a secure closure and a low recurrence rate. Surgical interventions consist of the approximation of the pubic rami with different materials such as suture materials and plaque or the application of different osteotomy types such as posterior iliac, anterior pelvic (pubic), diagonal iliac, horizontal iliac and posterior pelvic resection osteotomies. The age of the patient, the amount of pubic diastasis and history of previous operations that the patient has undergone should be considered during the operation planning. Pubic rami can be approximated without performing pelvic osteotomy in patients who are operated within the first 72 hours after birth. But, osteotomy is required in children older than 2 years of age with severe pubic diastasis, concomitant cloacal exstrophy and unsuccessful operation history. The surgical team should have enough knowledge and experience to perform different osteotomy types in case of need to combine anterior and posterior iliac osteotomies. With these multidisciplinary approaches, much more successful outcomes could be achieved.

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Pelvic osteotomy in the newborn classic bladder exstrophy closure: Complications and outcomes

European Urology Supplements ◽

10.1016/s1569-9056(17)30534-1 ◽

2017 ◽

Vol 16 (3) ◽

pp. e821 ◽

Cited By ~ 1

Author(s):

B. Sullivan ◽

D. Friedlander ◽

H. Di Carlo ◽

P. Sponseller ◽

J. Gearhart

Keyword(s):

Bladder Exstrophy ◽

Pelvic Osteotomy

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Advanced containment methods for Legg-Calvé-Perthes disease: triple pelvic osteotomy versus Chiari osteotomy

Hip International ◽

10.5301/hipint.5000569 ◽

2017 ◽

Vol 28 (3) ◽

pp. 297-301 ◽

Cited By ~ 4

Author(s):

Olivier Rosello ◽

Federico Solla ◽

Ioana Oborocianu ◽

Edouard Chau ◽

Tony ElHayek ◽

...

Keyword(s):

Pelvic Osteotomy ◽

Wilcoxon Test ◽

Perthes Disease ◽

Harris Hip Score ◽

Salter Osteotomy ◽

Stulberg Classification ◽

And Performance ◽

And Function ◽

Chiari Osteotomy

Introduction: The goal of intervention in Legg-Calvé-Perthes disease (LCPD) is to prevent femoral head deformation by containing the head within the acetabulum. Currently, surgical containment methods are the mainstay of treatment, and pelvic osteotomies have been shown to be successful. They include triple pelvic osteotomy (TPO), Salter osteotomy, Chiari osteotomy and shelf procedure. The purpose of this study was to compare clinical and radiologic results for Chiari osteotomy and TPO in LCPD. Methods: 29 children treated between 1980 and 2010 for LCPD in 2 centres were reviewed. 19 underwent TPO, and 10, Chiari osteotomy. Two independent observers assessed sequential radiographs and medical data. Each hip was preoperatively classed by clinical data, Catteral, Herring and Salter-Thompson classification, centre-edge angle (CE), and acetabular index (AI). The 2 groups were first tested for their comparability. After surgery the hips were classified by Stulberg classification, CE, AI, Harris Hip Score (HHS) and performance of further surgery. Chiari osteotomy and TPO have been secondary compared on these data by Wilcoxon test. Results: Average follow-up was 4.2 years. The 2 groups were comparable before surgery. At first and last follow-up examination, statistically significantly superior results in patients with TPO regarding Stulberg classification (p = 0.01), AI (p = 0.002), pain (p = 0.02) and function (p = 0.01) in the HHS score were found. No differences were noticed concerning CE angle. Conclusions: In our series, TPO provided better radiologic and clinical outcomes compared to Chiari osteotomy, specially concerning the final Stulberg classification. We concluded that TPO should be preferred when indicated.

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Pelvic osteotomy and symphysis reconstruction in bladder exstrophy: Early (2–6 years) results with a new (Double Door) symphysis reconstruction

Journal of Pediatric Urology ◽

10.1016/j.jpurol.2005.12.005 ◽

2006 ◽

Vol 2 (4) ◽

pp. 294-298 ◽

Cited By ~ 3

Author(s):

Bertil Romanus

Keyword(s):

Bladder Exstrophy ◽

Pelvic Osteotomy

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Oblique pelvic osteotomy in the treatment of bladder exstrophy in neonates

Journal of Pediatric Orthopaedics B ◽

10.1097/bpb.0000000000000614 ◽

2019 ◽

Vol 28 (3) ◽

pp. 207-213

Author(s):

Marco Giordano ◽

Antonio Di Lazzaro ◽

Vincenzo Guzzanti ◽

Silvia Careri ◽

Pietro Bagolan ◽

...

Keyword(s):

Bladder Exstrophy ◽

Pelvic Osteotomy

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Staged Male Bladder Exstrophy Repair

10.2310/uro.11026 ◽

2019 ◽

Author(s):

Timothy S. Baumgartner ◽

John P. Gearhart

Keyword(s):

Bladder Exstrophy ◽

Pelvic Osteotomy ◽

Postoperative Management ◽

Urinary Continence ◽

Antireflux Procedure ◽

Surgical Interventions ◽

Urethral Closure ◽

Bladder Neck Reconstruction ◽

Selection For ◽

Primary Bladder

This chapter details the latest surgical advances and outcomes in the modern surgical management of male classic bladder exstrophy to include patient selection for closure, operative considerations, newborn primary bladder and posterior urethral closure, early epispadias repair, bladder neck reconstruction with an antireflux procedure, and postoperative management. It highlights how to achieve the primary objectives of (1) a secure abdominal closure, (2) reconstruction of a functional and cosmetically acceptable penis, and (3) urinary continence with the preservation of renal function. In addition, it addresses the most common pitfalls and challenges encountered when accomplishing each of the major surgical interventions. This review contains 3 figures, 5 tables, and 47 references. Key Words: Congenital defect, Bladder exstrophy, Epispadias, Reconstruction, Urinary Continence, Magnetic Resonance Imaging, Pain management, Pelvic osteotomy

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