Abstract Book - 26th ESPU Congress, Joint Meeting with ICCS + SPU + AAP/SOU + AAPU + SFU

S26-14

(P)

COMBINING ROUTINE DELAYED, STAGED CLOSURE WITH PELVIC OSTEOTOMIES

AND EXTERNAL PELVIC FIXATION IS A SUCCESSFUL STRATEGY IN THE

TREATMENT OF BLADDER EXSTROPY

Rachel HARWOOD

, David J B KEENE

, Farhan ALI

, Sattar ALSHRYDA

, A MARIOTTO

and Raimondo M CERVELLIONE

1) Royal Manchester Children's Hospital, Paediatric Urology, Manchester, UNITED KINGDOM - 2) Royal Manchester

Children's Hospital, Paediatric Orthopaedics, Manchester, UNITED KINGDOM

PURPOSE

A successful primary bladder exstrophy closure (BEC) represents the initial fundamental step to obtaining micturating

continence in patients with bladder exstrophy. Every described technique to date carries a risk of significant

complication including wound dehiscence, suprapubic fistula formation and bladder prolapse.

The authors aim to assess whether these complications may be avoided by adopting a routine delayed, staged BEC in

combination with bilateral osteotomies and external pelvic fixation.

MATERIAL AND METHODS

Since 2007 the authors have routinely delayed BEC to 3-6 months of age, regardless of the size and quality of the

bladder template. Bladder pseudo-polyps, if present, are removed prior to closure. During BEC bilateral ureteric stents

and a suprapubic catheter are placed and left in situ for 4 weeks. BEC is combined with bilateral oblique pelvic

osteotomies, performed by the orthopaedic team, and an external fixator is placed for 3-4 weeks. A mermaid bandage is

applied to the legs without traction for 5-6 weeks.

Gender, age at closure and post-operative complications were the outcomes prospectively collected on consecutive

patients undergoing exstrophy closure at one institution between 2007 and 2014.

RESULTS

Forty-four patients were treated during the study period (31 male), including one redo surgery after complete

dehiscence of the original closure performed at another institution. Median age at time of bladder closure was 4 months

(IQR 2.75-6 months). All patients had a successful closure. No patients developed wound dehiscence, suprapubic fistula

or bladder prolapse. Patients have been followed up for a median duration of three years (IQR 1-5 years).

CONCLUSIONS

Delayed, staged bladder exstrophy closure in combination with bilateral osteotomies and external fixation application

provides a successful and reliable treatment without the risk of developing wound dehiscence, suprapubic fistula or

bladder prolapse.