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Applications of Osteotomy in the Cloacal Exstrophy Patient

1995; Lippincott Williams & Wilkins; Volume: 154; Issue: 2 Linguagem: Inglês

10.1016/s0022-5347(01)67187-8

1527-3792

Jacob Ben‐Chaim, Dennis S. Peppas, Paul D. Sponseller, Robert D. Jeffs, John P. Gearhart,

Congenital Anomalies and Fetal Surgery

No AccessJournal of UrologyExternal Genitalia1 Aug 1995Applications of Osteotomy in the Cloacal Exstrophy Patient Jacob Ben-Chaim, Dennis S. Peppas, Paul D. Sponseller, Robert D. Jeffs, and John P.* Gearhart Jacob Ben-ChaimJacob Ben-Chaim , Dennis S. PeppasDennis S. Peppas , Paul D. SponsellerPaul D. Sponseller , Robert D. JeffsRobert D. Jeffs , and John P.* GearhartJohn P.* Gearhart View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)67187-8AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail During the last 18 years we treated 22 patients with cloacal exstrophy of whom 13 were referred for further treatment after initial treatment elsewhere. One patient underwent cystectomy with ileal conduit urinary diversion soon after birth and 9 of the remaining 21 underwent initial closure without osteotomy. Of these 9 patients significant complications developed in 8 (89 percent) after bladder closure, including dehiscence in 6 (1 underwent 2 unsuccessful closures), a vesicocutaneous fistula and postoperative ventral hernia in 1, and bladder prolapse in 1. In contrast, complications developed in only 2 of the 12 patients (17 percent) who underwent osteotomy at the time of initial closure, including bladder dehiscence in 1 and significant prolapse in 1. Patients who underwent osteotomy and those who did not were similar in terms of the size of omphalocele, presence of myelomeningocele and time of primary closure. We also found that osteotomy or failed closure has no effect on the eventual continence of cloacal exstrophy patients. While osteotomy is not the only variable involved in successful cloacal exstrophy closure, our results indicate the need for osteotomy in these patients to increase the success rate at the time of initial bladder closure. References 1 : Vesicointestinal fissure. J. Urol.1964; 92: 490. Link, Google Scholar 2 : In utero prenatal ultrasonic diagnosis of a rare case of cloacal exstrophy. J. Clin. Ultrasound1985; 13: 500. Crossref, Medline, Google Scholar 3 : Techniques to create urinary continence in the cloacal exstrophy patient. J. Urol., part 21991; 146: 616. Abstract, Google Scholar 4 : Modern treatment of cloacal exstrophy. J. Ped. Surg.1991; 26: 444. Google Scholar 5 : The anatomy of the pelvis in the exstrophy complex. J. Bone Joint Surg.1995; 77: 177. Google Scholar 6 : Anterior innominate osteotomies for failure or late closure of bladder exstrophy. J. Urol.1991; 146: 137. Link, Google Scholar 7 : Anterior pelvic osteotomy. A new operative technique facilitating primary bladder exstrophy closure. Brit. J. Urol.1989; 64: 641. Google Scholar 8 : Pelvic osteotomy for bladder exstrophy. J. Ped. Orthoped.1993; 13: 214. Google Scholar 9 : Iliac osteotomy: a model to compare the options in bladder and cloacal exstrophy reconstruction. J. Urol.1994; 151: 182. Link, Google Scholar 10 : The importance of a successful initial bladder closure in the surgical management of classical bladder exstrophy: analysis of 144 patients treated at The Johns Hopkins Hospital between 1975 and 1985. J. Urol.1987; 137: 258. Link, Google Scholar 11 : Management of the failed exstrophy closure. J. Urol., part 21991; 146: 610. Abstract, Google Scholar 12 : Closure of the exstrophic bladder: an evaluation of the factors leading to its success and its importance on urinary continence. J. Urol., part 21989; 142: 522. Abstract, Google Scholar Division of Pediatric Urology, Department of Urology, James Buchanan Brady Urological Institute and Division of Pediatric Orthopedics, Department of Orthopedic Surgery, The Johns Hopkins Hospital and University School of Medicine, Baltimore, Maryland.© 1995 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited bySuson K, Novak T, Gupta A, Benson J, Sponseller P and Gearhart J (2010) Neuro-Orthopedic Manifestations of the Omphalocele Exstrophy Imperforate Anus Spinal Defects ComplexJournal of Urology, VOL. 184, NO. 4S, (1651-1655), Online publication date: 1-Oct-2010.Gearhart J (2007) Editorial CommentJournal of Urology, VOL. 178, NO. 4S, (1635-1635), Online publication date: 1-Oct-2007.SILVER R, SPONSELLER P and GEARHART J (2018) STAGED CLOSURE OF THE PELVIS IN CLOACAL EXSTROPHY: FIRST DESCRIPTION OF A NEW APPROACHJournal of Urology, VOL. 161, NO. 1, (263-266), Online publication date: 1-Jan-1999.MATHEWS R, JEFFS R, REINER W, DOCIMO S and GEARHART J (2018) CLOACAL EXSTROPHY-IMPROVING THE QUALITY OF LIFEJournal of Urology, VOL. 160, NO. 6 Part 2, (2452-2456), Online publication date: 1-Dec-1998.Frey P (2018) Bilateral Anterior Pubic Osteotomy in Bladder Exstrophy ClosureJournal of Urology, VOL. 156, NO. 2S, (812-815), Online publication date: 1-Aug-1996. Volume 154Issue 2August 1995Page: 865-867 Advertisement Copyright & Permissions© 1995 by American Urological Association, Inc.MetricsAuthor Information Jacob Ben-Chaim More articles by this author Dennis S. Peppas More articles by this author Paul D. Sponseller More articles by this author Robert D. Jeffs More articles by this author John P.* Gearhart More articles by this author Expand All Advertisement PDF downloadLoading ...