The addition of pelvic osteotomy to the armamentarium of tools for correction of classic
bladder exstrophy (CBE) and cloacal exstrophy (CE) has undeniably served as one of
the most effective advancements in improving the likelihood of successful primary
bladder closure. Osteotomy-related complications have been studied and documented
extensively in patients with CBE, yet evaluation remains limited in CE concordant
with its relative rarity.
To compare orthopedic complications in patients with CBE and CE who underwent primary
bladder closure with osteotomy.
A prospectively maintained, IRB-approved database of 1401 exstrophy-epispadias patients
was reviewed for patients with CBE or CE after primary closure and pelvic osteotomy
performed at a single institution from 1975 to 2021. Failed closure was defined as
dehiscence, bladder prolapse, or vesicocutaneous fistula at any point. Surgery or
anesthesia-related complications were captured within 6 weeks of osteotomy or closure.
A total of 146 patients were included in the analysis with 109 and 37 patients with
CBE and CE, respectively. Between the CBE and CE cohorts, there were significant differences
in median age at primary closure (68 days [IQR 10–260] vs 597 [448–734]; p < 0.001),
diastasis width (4 cm IQR [3.8–4.6] vs 6.1 [5.0–7.2]; p < 0.001), osteotomy at time
of closure (99.1% vs 75.7%; p < 0.001), and utilization of external hip fixation (67.9%
vs 89.2%; p = 0.011). There was no significant difference by gender, osteotomy technique,
or hip immobilization technique.
Regarding exstrophy closure outcomes, there were 5 failures in the CBE group and 1
in the CE group (p = 1.000). Complications were experienced in 38.5% and 56.8% of
CBE and CE patients (p = 0.054) with a significant difference in orthopedic complications
(primarily consisting of superficial pin-site infections) between the cohorts (4.6%
vs 16.2%, p = 0.031). There was no significant difference in grade 3 or higher complications
between cohorts (5.5% vs 13.5%, p = 0.147).
This was the first study comparing orthopedic complications after osteotomy between
CBE and CE, providing valuable insight into which factors vary among cohorts and which
are associated with increased complication rates. Despite availability of high case
numbers for these rare disorders, the analysis continued to be limited sample size
and missing data for retrospective analysis.
While exstrophy closure success and overall complications rates are similar in patients
with CBE and CE, patients with CE experience more superficial pin-site infections
after pelvic osteotomy. External hip fixation may be associated with the increase
in orthopedic complications, though further research is required to elucidate the
underlying cause of these complications.