Anterior Pelvic Osteotomy. A New Operative Technique Facilitating Primary Bladder Exstrophy Closure

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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PEDIATRIC UROLOGY Complications after primary bladder exstrophy closure – role of pelvic osteotomy

Central European Journal of Urology ◽

10.5173/ceju.2013.01.art31 ◽

2013 ◽

Vol 65 ◽

pp. 104-108 ◽

Cited By ~ 5

Author(s):

Małgorzata Baka–Ostrowska ◽

Kinga Kowalczyk ◽

Karina Felberg ◽

Zbigniew Wawer

Keyword(s):

Bladder Exstrophy ◽

Pelvic Osteotomy ◽

Pediatric Urology ◽

Primary Bladder

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Faculty Opinions recommendation of Primary bladder exstrophy closure in neonates: challenging the traditions.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718043490.793493003 ◽

2014 ◽

Author(s):

Chris Cooper ◽

Douglas Storm

Keyword(s):

Bladder Exstrophy ◽

Primary Bladder

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Is Pelvic Osteotomy Associated with Lower Risk of Pelvic Organ Prolapse in Postpubertal Females with Classic Bladder Exstrophy?

The Journal of Urology ◽

10.1016/j.juro.2012.08.034 ◽

2012 ◽

Vol 188 (6) ◽

pp. 2343-2346 ◽

Cited By ~ 14

Author(s):

Ifeanyi Anusionwu ◽

Nima Baradaran ◽

Bruce J. Trock ◽

Andrew A. Stec ◽

John P. Gearhart ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Lower Risk ◽

Bladder Exstrophy ◽

Pelvic Osteotomy ◽

Pelvic Organ

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Comparison of posterior and anterior pelvic osteotomy for bladder exstrophy complex

Journal of Pediatric Orthopaedics B ◽

10.1097/01.bpb.0000191873.61635.10 ◽

2006 ◽

Vol 15 (2) ◽

pp. 141-146 ◽

Cited By ~ 21

Author(s):

Shinichi Satsuma ◽

Daisuke Kobayashi ◽

Shinichi Yoshiya ◽

Masahiro Kurosaka

Keyword(s):

Bladder Exstrophy ◽

Pelvic Osteotomy

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Orthopaedic Management of Bladder Exstrophy

Turkish Association of Pediatric Surgeons ◽

10.5222/jtaps.2021.25986 ◽

2021 ◽

Author(s):

R. Özgür Özer

Keyword(s):

Abdominal Wall ◽

Bladder Exstrophy ◽

Pelvic Osteotomy ◽

Orthopedic Procedures ◽

Suture Materials ◽

Cloacal Exstrophy ◽

Surgical Interventions ◽

Pubic Rami ◽

Multi Stage ◽

Pubic Diastasis

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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Hip Configuration and Function in Bladder Exstrophy Treated Without Pelvic Osteotomy

Journal of Pediatric Orthopaedics B ◽

10.1097/01202412-199605020-00012 ◽

1996 ◽

Vol 5 (2) ◽

pp. 121-122 ◽

Cited By ~ 11

Author(s):

Sofia Nordin ◽

Christina Clementson ◽

Kristian Herrlin ◽

Gunnar Hagglund

Keyword(s):

Bladder Exstrophy ◽

Pelvic Osteotomy ◽

And Function

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Urinary Bladder Adenocarcinoma Metastatic to the Abdominal Wall: Report of a Case with Cytohistologic Correlation

Case Reports in Pathology ◽

10.1155/2016/8608412 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Vikas Nath ◽

Mithra Baliga

Keyword(s):

Abdominal Wall ◽

Specific Antigen ◽

Bladder Exstrophy ◽

Signet Ring Cell ◽

Ct Guided ◽

Bladder Dome ◽

Primary Bladder ◽

Rare Malignancy ◽

Urachal Adenocarcinoma ◽

Bladder Adenocarcinoma

We report a case of adenocarcinoma metastatic to the abdominal wall in a 71-year-old man with a history of primary bladder adenocarcinoma. CT-guided core biopsy was performed; imprints and histologic sections showed malignant glands lined by tumor cells with hyperchromatic nuclei and prominent nucleoli, infiltrating through skeletal muscle. Immunohistochemistry revealed positivity for CK7, membranous/cytoplasmicβ-catenin, caudal-type homeobox transcription factor 2 (CDX2), andα-methylacyl coenzyme A racemase and negativity for CK20, p63, prostate-specific antigen (PSA), and prostate-specific acid phosphatase (PSAP). These findings were interpreted as metastatic adenocarcinoma, consistent with bladder primary. Primary bladder adenocarcinoma is a rare malignancy arising within glandular metaplasia and is associated with cystitis cystica and cystitis glandularis. Predisposing factors include bladder exstrophy, schistosomiasis, and other causes of chronic bladder irritation. This tumor is divided into intestinal, clear cell, and signet ring cell subtypes. Treatment involves radical cystectomy with pelvic lymph node dissection, and prognosis is unfavorable. Primary bladder adenocarcinoma should be differentiated from urachal adenocarcinoma, which arises from urachal remnants near the bladder dome, and secondary adenocarcinoma, or vesical involvement by adenocarcinoma from a different primary. CK7, CK20, CDX2, thrombomodulin, andβ-catenin can help distinguish primary bladder adenocarcinoma from colonic adenocarcinoma; PSA and PSAP can help distinguish primary bladder adenocarcinoma from prostate adenocarcinoma.

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