Predictors of a successful primary bladder closure in cloacal exstrophy: A multivariable analysis

John Jayman, Ali Tourchi, Zhaoyong Feng, Bruce Trock, Mahir Maruf, Karl Benz, Matthew Kasprenski, Timothy Baumgartner, Daniel Friedlander, Paul David Sponseller, John Phillip Gearhart

Research output: Contribution to journalArticle

Abstract

Purpose: To investigate the factors affecting primary bladder closure in cloacal exstrophy (CE). A successful primary closure is important for optimizing reconstructive outcomes, and it is a critical first-step in the reconstruction of CE. The authors' hypothesize that a smaller diastasis and use of an osteotomy are independent predictors of a successful closure. Methods: A prospectively maintained database of 1332 exstrophy-epispadias complex (EEC) patients was reviewed for CE patients closed between 1975 and 2015. Univariate and multivariable analyses were performed to identify significant factors associated with CE primary bladder closure. Results: Of 143 CE patients identified, 99 patients met inclusion criteria. Median follow-up time was 8.82 [IQR 5.43–14.26] years. In the multivariable model, the odds of having a successful closure are about 4 times greater for the staged cloacal approach compared to the 1-stage approach (OR, 3.7; 95% CI 1.2–11.5; p-value = 0.023). Also, having an osteotomy increases the chance of a successful closure by almost six-fold (OR, 5.8; 95% CI 1.7–19.6; p-value = 0.004). Conclusions: Using the staged approach with a pelvic osteotomy is paramount to a successful primary closure in CE. The authors strongly recommend using the staged approach and osteotomy as these factors independently increase the chance for a successful primary bladder closure. Study Type: Therapeutic study. Level of Evidence: Level III, Retrospective comparative study.

Original languageEnglish (US)
JournalJournal of Pediatric Surgery
DOIs
StateAccepted/In press - Jan 1 2018

Keywords

  • Bladder closure
  • Cloacal exstrophy
  • Exstrophy-epispadias complex
  • Osteotomy
  • Staged

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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