The failed bladder closure in cloacal exstrophy

Management and outcomes

Rachel Davis, Amol Sood, Mahir Maruf, Prachi Singh, Matthew C. Kasprenski, Heather DiCarlo, John Phillip Gearhart

Research output: Contribution to journalArticle

Abstract

Purpose: Cloacal exstrophy (CE) is the most severe presentation of the Exstrophy-Epispadias Complex (EEC) and is associated with an omphalocele, making the bladder and abdominal wall closure difficult. If the bladder closure fails, a secondary closure is necessary. The objective of this study is to identify patient or surgical factors associated with a successful secondary closure. Methods: The institution's EEC database was reviewed for CE patients between 1975 and 2015. Inclusion criteria included a failed primary bladder closure with a secondary closure. Patient demographics, surgical factors and outcomes of the secondary bladder closure were reviewed. Results: Twenty-four patients met inclusion criteria. 8/8 patients had a successful two-staged closure at the author's institution (100%); 2/16 patients had a successful closure at an outside institution (12.5%). Older median age at secondary closure was associated with outcome, p = 0.045. Pelvic osteotomy was associated with successful secondary closure, p = 0.013. Using Buck's immobilization with external fixation was associated with a higher proportion of successful secondary closures compared to Spica cast, p = 0.012. Conclusion: Successful reclosure in CE patients is associated with the use of osteotomy as well as Buck's immobilization with external fixation. While successful reclosure can be achieved, it is often at the cost of multiple procedures and, therefore, all efforts should be expended to achieve a successful primary closure. Type of Study: Prognostic. Level of Evidence: III.

Original languageEnglish (US)
JournalJournal of pediatric surgery
DOIs
StatePublished - Jan 1 2019

Fingerprint

Urinary Bladder
Epispadias
Osteotomy
Immobilization
Umbilical Hernia
Abdominal Wall
Demography
Databases

Keywords

  • Bladder exstrophy
  • Cloacal exstrophy
  • Osteotomy
  • Pediatric urology

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

The failed bladder closure in cloacal exstrophy : Management and outcomes. / Davis, Rachel; Sood, Amol; Maruf, Mahir; Singh, Prachi; Kasprenski, Matthew C.; DiCarlo, Heather; Gearhart, John Phillip.

In: Journal of pediatric surgery, 01.01.2019.

Research output: Contribution to journalArticle

Davis, Rachel ; Sood, Amol ; Maruf, Mahir ; Singh, Prachi ; Kasprenski, Matthew C. ; DiCarlo, Heather ; Gearhart, John Phillip. / The failed bladder closure in cloacal exstrophy : Management and outcomes. In: Journal of pediatric surgery. 2019.
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