Abstract

Bladder exstrophy (ectopia vesicae) it’s a congenital anomalies that exist along the spectrum of the extrophy – epispadius complex and involve protrusion of the urinary bladder through abdominal wall defect with variable presentations including abnormalities of the bony pelvis, pelvic floor and genitalia. It is a rare congenital anomaly and observed in one of every 10,000-50,000 live births, and about four times more often in boys than in girls. The classical approach for the repair has been disbelieving the need for pelvic osteotomy adjunct to bladder extrophy repair performed within 72 hours of life due to the relative malleability. The current surgical approach consists of early closure with pelvic osteotomy and later surgery for continence to achieve satisfactory urinary storage, continence and bladder emptying by the time the child enters school. Several types of pelvic osteotomies used adjunctively to primary repair. Anterior pelvic osteotomy of the superior pubic ramus, seems to be a safe and quick method combined with the repair to obtain tension-free approximation of the symphysis pubis and better results. This study conducted to evaluate the feasibility of the bilateral anterior pubic osteotomy as adjunctive measure to simple closure of the bladder exstrophy and achieving a tension-free approximation of the symphysis pubis and abdominal wall. Prospective study between January 2006 and January 2017, invole a total of 14 patients (12 males and 2 females) with bladder exstrophy, 2 of them were recurrent. All cases underwent elective surgery for repair, which include dissection of the exstrophic bladder from the abdominal wall, closure of the bladder and reconstruction of the urethra, with identification of pubic bone from attached tissues, which makes osteotomy of the superior pubic ramus easy, thus tension free approximation and less dehiscence. Fourteen patients with Bladder Extrophy were operated. Twelve 85.7% of the patients were males and only two (14.2%) was female. Their ages at the time of the procedure ranged from 2 to 5 days for the primary cases and (7, 8) months for the recurrent two cases. Successful bladder closure was achieved in 13(92.8%) of the 14 patients operated. The bilateral anterior pelvic osteotomy was safe, quick with minimal blood loss and can be performed by the pediatric surgeon without the need to an orthopedic surgeon. Bilateral anterior pelvic osteotomy of superior pubic rami is a sufficient adjunctive measure to bladder exstrophy repair, to obtain tension-free approximation of the symphysis pubis, and hence diminishes the risk of wound dehiscence whether primary or re-do cases. It provides further advantages namely, ease and rapidity, minimal blood loss, and no need for an extra skin incision or patient’s repositioning.

Keywords: Bladder exstrophy, pelvic osteotomy, Primary, Recurrent.