Complications of bladder closure in cloacal exstrophy: Do osteotomy and reoperative closure factor in?

Research output: Contribution to journalArticle

Abstract

Background/purpose: The aims of surgical management in cloacal exstrophy (CE) have shifted to optimizing outcomes and quality of life while minimizing morbidity. This report reviews the single-institution experience of complications of bladder closure in CE. Methods: Patients with CE were identified from a prospectively-maintained bladder exstrophy-epispadias complex database. Operative and follow-up data were analyzed to compare complications and failure rates of bladder closure between closures performed with and without osteotomy and primary versus reoperative closures. Results: Of 134 patients followed with CE, 112 met inclusion criteria. Median follow-up time was 3.05. years. The failure rate among 112 primary closures (mean age 8.4. months) was 31.3% versus 51.9% in reoperative closures (mean age 19.7. months) (p = 0.044). Complication rate among primary and reoperative closures was 17.9% and 33.3%, respectively (p = 0.076). For closures with pelvic osteotomy, failure rate was 24.0% versus 45.9% without osteotomy (p = 0.018). Among primary closures with osteotomy, the complication rate was 21.3% versus 10.8% without osteotomy (p = 0.171). Conclusions: Complications of bladder closure are common in CE. Pelvic osteotomy reduces failure rates without a significant rise in complications, which are often minor. There was no statistically significant difference in complication rates between reoperative and primary closures. However, reoperative closures were more likely to fail, emphasizing the importance of a successful primary closure. Level of evidence: II: retrospective study.

Original languageEnglish (US)
JournalJournal of Pediatric Surgery
DOIs
StateAccepted/In press - Oct 14 2016

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Osteotomy
Urinary Bladder
Retrospective Studies
Quality of Life
Databases
Morbidity

Keywords

  • Bladder exstrophy and epispadias complex
  • Cloacal exstrophy
  • OEIS complex
  • Osteotomy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

@article{327aaa59687b4d3fbc34a263e529dd8d,
title = "Complications of bladder closure in cloacal exstrophy: Do osteotomy and reoperative closure factor in?",
abstract = "Background/purpose: The aims of surgical management in cloacal exstrophy (CE) have shifted to optimizing outcomes and quality of life while minimizing morbidity. This report reviews the single-institution experience of complications of bladder closure in CE. Methods: Patients with CE were identified from a prospectively-maintained bladder exstrophy-epispadias complex database. Operative and follow-up data were analyzed to compare complications and failure rates of bladder closure between closures performed with and without osteotomy and primary versus reoperative closures. Results: Of 134 patients followed with CE, 112 met inclusion criteria. Median follow-up time was 3.05. years. The failure rate among 112 primary closures (mean age 8.4. months) was 31.3{\%} versus 51.9{\%} in reoperative closures (mean age 19.7. months) (p = 0.044). Complication rate among primary and reoperative closures was 17.9{\%} and 33.3{\%}, respectively (p = 0.076). For closures with pelvic osteotomy, failure rate was 24.0{\%} versus 45.9{\%} without osteotomy (p = 0.018). Among primary closures with osteotomy, the complication rate was 21.3{\%} versus 10.8{\%} without osteotomy (p = 0.171). Conclusions: Complications of bladder closure are common in CE. Pelvic osteotomy reduces failure rates without a significant rise in complications, which are often minor. There was no statistically significant difference in complication rates between reoperative and primary closures. However, reoperative closures were more likely to fail, emphasizing the importance of a successful primary closure. Level of evidence: II: retrospective study.",
keywords = "Bladder exstrophy and epispadias complex, Cloacal exstrophy, OEIS complex, Osteotomy",
author = "Friedlander, {Daniel A.} and Heather DiCarlo and Sponseller, {Paul David} and Gearhart, {John Phillip}",
year = "2016",
month = "10",
day = "14",
doi = "10.1016/j.jpedsurg.2016.12.002",
language = "English (US)",
journal = "Journal of Pediatric Surgery",
issn = "0022-3468",
publisher = "W.B. Saunders Ltd",

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T1 - Complications of bladder closure in cloacal exstrophy

T2 - Do osteotomy and reoperative closure factor in?

AU - Friedlander, Daniel A.

AU - DiCarlo, Heather

AU - Sponseller, Paul David

AU - Gearhart, John Phillip

PY - 2016/10/14

Y1 - 2016/10/14

N2 - Background/purpose: The aims of surgical management in cloacal exstrophy (CE) have shifted to optimizing outcomes and quality of life while minimizing morbidity. This report reviews the single-institution experience of complications of bladder closure in CE. Methods: Patients with CE were identified from a prospectively-maintained bladder exstrophy-epispadias complex database. Operative and follow-up data were analyzed to compare complications and failure rates of bladder closure between closures performed with and without osteotomy and primary versus reoperative closures. Results: Of 134 patients followed with CE, 112 met inclusion criteria. Median follow-up time was 3.05. years. The failure rate among 112 primary closures (mean age 8.4. months) was 31.3% versus 51.9% in reoperative closures (mean age 19.7. months) (p = 0.044). Complication rate among primary and reoperative closures was 17.9% and 33.3%, respectively (p = 0.076). For closures with pelvic osteotomy, failure rate was 24.0% versus 45.9% without osteotomy (p = 0.018). Among primary closures with osteotomy, the complication rate was 21.3% versus 10.8% without osteotomy (p = 0.171). Conclusions: Complications of bladder closure are common in CE. Pelvic osteotomy reduces failure rates without a significant rise in complications, which are often minor. There was no statistically significant difference in complication rates between reoperative and primary closures. However, reoperative closures were more likely to fail, emphasizing the importance of a successful primary closure. Level of evidence: II: retrospective study.

AB - Background/purpose: The aims of surgical management in cloacal exstrophy (CE) have shifted to optimizing outcomes and quality of life while minimizing morbidity. This report reviews the single-institution experience of complications of bladder closure in CE. Methods: Patients with CE were identified from a prospectively-maintained bladder exstrophy-epispadias complex database. Operative and follow-up data were analyzed to compare complications and failure rates of bladder closure between closures performed with and without osteotomy and primary versus reoperative closures. Results: Of 134 patients followed with CE, 112 met inclusion criteria. Median follow-up time was 3.05. years. The failure rate among 112 primary closures (mean age 8.4. months) was 31.3% versus 51.9% in reoperative closures (mean age 19.7. months) (p = 0.044). Complication rate among primary and reoperative closures was 17.9% and 33.3%, respectively (p = 0.076). For closures with pelvic osteotomy, failure rate was 24.0% versus 45.9% without osteotomy (p = 0.018). Among primary closures with osteotomy, the complication rate was 21.3% versus 10.8% without osteotomy (p = 0.171). Conclusions: Complications of bladder closure are common in CE. Pelvic osteotomy reduces failure rates without a significant rise in complications, which are often minor. There was no statistically significant difference in complication rates between reoperative and primary closures. However, reoperative closures were more likely to fail, emphasizing the importance of a successful primary closure. Level of evidence: II: retrospective study.

KW - Bladder exstrophy and epispadias complex

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KW - OEIS complex

KW - Osteotomy

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