Pelvic osteotomy and symphysis reconstruction in bladder exstrophy: Early (2–6 years) results with a new (Double Door) symphysis reconstruction

Abstract 

Objectives

To describe the 2–6-years follow up of a combination of oblique pelvic osteotomies and a new method for symphysis reconstruction, with the aim of creating a stable pelvic ring that will not widen during growth.

Materials and methods

Five children were operated on between 1998 and 2003 at the age of 2 days to 8 months. One child had a cloacal exstrophy. A ‘Double Door’ plasty was performed from hinged cartilaginous flaps at either side of the symphysis diastasis. This was followed by primary fixation with heavy resorbable sutures and 6 weeks in vertical traction for the younger ones and a pelvic external fixator (for 3 months) for the older (>6 months).

Results

One child had a deep infection at 2 weeks postoperatively and healed with gradually increasing diastasis (39mm at 3 years+2 months). All the others healed uneventfully and the symphysis stabilized after a few weeks. All had a stable symphysis diastasis of only 15–25mm during the observation period.

Conclusions

A stable, narrow symphysis can be created by combining oblique pelvic osteotomies with a Double Door plasty, allowing uro-genital reconstruction without interfering with pelvic growth or hip function.

Keywords: Bladder exstrophy, Pelvic osteotomy, Symphysis reconstruction, Early results