The role of osteotomy in surgical repair of bladder exstrophy

Aaron T. Wild, Paul David Sponseller, Andrew A. Stec, John Phillip Gearhart

Research output: Contribution to journalArticle

Abstract

Classic bladder exstrophy (CBE) patients are born with a pubic diastasis that increases steadily with age from a mean value of 4 cm at birth to a mean of 8 cm at age 10, compared with a mean normal width of the pubic symphysis of 0.6 cm at all ages. The width of the sacrum and length of the posterior (iliac) segment of the pelvis in CBE patients are normal; however, the anterior (ischiopubic) segment of the pelvis is a mean 30% shorter and both the anterior and posterior segments are externally rotated compared to controls. The main role of osteotomy in treatment of CBE appears to be to relax tension on the bladder and repaired abdominal wall during wound-healing. Anterior innominate osteotomy with optional posterior vertical iliac osteotomy presents several advantages over the prior conventional technique of posterior iliac osteotomy. These include (a) less intraoperative blood loss, (b) better apposition and mobility of the pubic rami at the time of closure, (c) allowance for placement of an external fixator under direct vision, (d) allowance for secure external fixation in children over 6 months old, and (e) no requirement to turn the patient during the operation.

Original languageEnglish (US)
Pages (from-to)71-78
Number of pages8
JournalSeminars in Pediatric Surgery
Volume20
Issue number2
DOIs
StatePublished - May 2011

Fingerprint

Bladder Exstrophy
Osteotomy
Pelvis
Pubic Symphysis
External Fixators
Sacrum
Abdominal Wall
Wound Healing
Urinary Bladder
Parturition

Keywords

  • Exstrophy
  • Fixator
  • Osteotomy
  • Rami

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

The role of osteotomy in surgical repair of bladder exstrophy. / Wild, Aaron T.; Sponseller, Paul David; Stec, Andrew A.; Gearhart, John Phillip.

In: Seminars in Pediatric Surgery, Vol. 20, No. 2, 05.2011, p. 71-78.

Research output: Contribution to journalArticle

@article{4d37312a9bab4390bafb811444280681,
title = "The role of osteotomy in surgical repair of bladder exstrophy",
abstract = "Classic bladder exstrophy (CBE) patients are born with a pubic diastasis that increases steadily with age from a mean value of 4 cm at birth to a mean of 8 cm at age 10, compared with a mean normal width of the pubic symphysis of 0.6 cm at all ages. The width of the sacrum and length of the posterior (iliac) segment of the pelvis in CBE patients are normal; however, the anterior (ischiopubic) segment of the pelvis is a mean 30{\%} shorter and both the anterior and posterior segments are externally rotated compared to controls. The main role of osteotomy in treatment of CBE appears to be to relax tension on the bladder and repaired abdominal wall during wound-healing. Anterior innominate osteotomy with optional posterior vertical iliac osteotomy presents several advantages over the prior conventional technique of posterior iliac osteotomy. These include (a) less intraoperative blood loss, (b) better apposition and mobility of the pubic rami at the time of closure, (c) allowance for placement of an external fixator under direct vision, (d) allowance for secure external fixation in children over 6 months old, and (e) no requirement to turn the patient during the operation.",
keywords = "Exstrophy, Fixator, Osteotomy, Rami",
author = "Wild, {Aaron T.} and Sponseller, {Paul David} and Stec, {Andrew A.} and Gearhart, {John Phillip}",
year = "2011",
month = "5",
doi = "10.1053/j.sempedsurg.2010.12.002",
language = "English (US)",
volume = "20",
pages = "71--78",
journal = "Seminars in Pediatric Surgery",
issn = "1055-8586",
publisher = "W.B. Saunders Ltd",
number = "2",

}

TY - JOUR

T1 - The role of osteotomy in surgical repair of bladder exstrophy

AU - Wild, Aaron T.

AU - Sponseller, Paul David

AU - Stec, Andrew A.

AU - Gearhart, John Phillip

PY - 2011/5

Y1 - 2011/5

N2 - Classic bladder exstrophy (CBE) patients are born with a pubic diastasis that increases steadily with age from a mean value of 4 cm at birth to a mean of 8 cm at age 10, compared with a mean normal width of the pubic symphysis of 0.6 cm at all ages. The width of the sacrum and length of the posterior (iliac) segment of the pelvis in CBE patients are normal; however, the anterior (ischiopubic) segment of the pelvis is a mean 30% shorter and both the anterior and posterior segments are externally rotated compared to controls. The main role of osteotomy in treatment of CBE appears to be to relax tension on the bladder and repaired abdominal wall during wound-healing. Anterior innominate osteotomy with optional posterior vertical iliac osteotomy presents several advantages over the prior conventional technique of posterior iliac osteotomy. These include (a) less intraoperative blood loss, (b) better apposition and mobility of the pubic rami at the time of closure, (c) allowance for placement of an external fixator under direct vision, (d) allowance for secure external fixation in children over 6 months old, and (e) no requirement to turn the patient during the operation.

AB - Classic bladder exstrophy (CBE) patients are born with a pubic diastasis that increases steadily with age from a mean value of 4 cm at birth to a mean of 8 cm at age 10, compared with a mean normal width of the pubic symphysis of 0.6 cm at all ages. The width of the sacrum and length of the posterior (iliac) segment of the pelvis in CBE patients are normal; however, the anterior (ischiopubic) segment of the pelvis is a mean 30% shorter and both the anterior and posterior segments are externally rotated compared to controls. The main role of osteotomy in treatment of CBE appears to be to relax tension on the bladder and repaired abdominal wall during wound-healing. Anterior innominate osteotomy with optional posterior vertical iliac osteotomy presents several advantages over the prior conventional technique of posterior iliac osteotomy. These include (a) less intraoperative blood loss, (b) better apposition and mobility of the pubic rami at the time of closure, (c) allowance for placement of an external fixator under direct vision, (d) allowance for secure external fixation in children over 6 months old, and (e) no requirement to turn the patient during the operation.

KW - Exstrophy

KW - Fixator

KW - Osteotomy

KW - Rami

UR - http://www.scopus.com/inward/record.url?scp=79953097207&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79953097207&partnerID=8YFLogxK

U2 - 10.1053/j.sempedsurg.2010.12.002

DO - 10.1053/j.sempedsurg.2010.12.002

M3 - Article

C2 - 21453849

AN - SCOPUS:79953097207

VL - 20

SP - 71

EP - 78

JO - Seminars in Pediatric Surgery

JF - Seminars in Pediatric Surgery

SN - 1055-8586

IS - 2

ER -