PURPOSE: This study examines a large single-institution experience with cloacal exstrophy patients, analyzing patient demographics and surgical strategies predictive of bladder closure outcomes.
METHODS: One hundred patients with cloacal exstrophy were identified. Complete closure history including demographics, operative history, and outcomes was available on 60 patients. Twenty-six patients with a history of failed initial bladder closure were compared to 34 with a history of successful initial bladder closure. Univariate logistic regression analysis was used to compare the two groups.
RESULTS: Median follow up time after initial closure was 9years (range: 13months-29years). A 1cm increase in pre-closure diastasis resulted in a 2.64 increase in the odds of initial closure failure (p=0.004). Protective strategies against failure included delaying closure (per month) (OR=0.894, p=0.009), employing pelvic osteotomies (OR=0.095, p< 0.001), and applying external fixation (OR=0.024; p=0.001). Among patients who underwent osteotomy (31% of patients in the failed group, 82% in the successful group), a longer delay between osteotomy and closure (OR=0.033; p=0.005) was also protective against failure.
CONCLUSION: Patients with a large diastasis are more likely to fail initial closure. Delaying initial closure for at least 3months, performing pelvic osteotomy, and using an external fixation device post-operatively are strategies that improve closure success.
Written by:
Shah BB, Di Carlo H, Goldstein SD, Pierorazio PM, Inouye BM, Massanyi EZ, Kern A, Koshy J, Sponseller P, Gearhart JP. Are you the author?
University of South Florida Morsani College of Medicine, Department of Urology, South Tampa Center of Advanced Health Care, Tampa FL 33606, USA; The Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, Suite 7302, Baltimore, MD 21287, USA; The Johns Hopkins University School of Medicine, Division of Pediatric Surgery, Charlotte Bloomberg Children's Hospital, 1800 Orleans St., Baltimore, MD 21287, USA; The Johns Hopkins University School of Medicine, Department of Diagnostic Radiology, 600N. Wolfe Street, Baltimore, MD 21287, USA; The Johns Hopkins University School of Medicine, Division of Pediatric Orthopaedics, The Johns Hopkins Outpatient Center, 601N. Caroline St., Room 5152, Baltimore, MD 21287, USA.
Reference: J Pediatr Surg. 2014 Jun;49(6):1036-9; discussion 1039-40.
doi: 10.1016/j.jpedsurg.2014.01.047
PubMed Abstract
PMID: 24888858