1614 IS PELVIC OSTEOTOMY ASSOCIATED WITH LOWER RISK OF PELVIC ORGAN PROLAPSE IN PATIENTS WITH CLASSIC BLADDER EXSTROPHY?

Abstract

You have accessJournal of UrologyPediatrics: Congenital Anomalies - Lower Urinary Tract & Genitalia II1 Apr 20121614 IS PELVIC OSTEOTOMY ASSOCIATED WITH LOWER RISK OF PELVIC ORGAN PROLAPSE IN PATIENTS WITH CLASSIC BLADDER EXSTROPHY? Ifeanyi Anusionwu, Nima Baradaran, Bruce Trock, Andrew Stec, John Gearhart, and E. James Wright Ifeanyi AnusionwuIfeanyi Anusionwu Baltimore, MD More articles by this author , Nima BaradaranNima Baradaran Baltimore, MD More articles by this author , Bruce TrockBruce Trock Baltimore, MD More articles by this author , Andrew StecAndrew Stec Baltimore, MD More articles by this author , John GearhartJohn Gearhart Baltimore, MD More articles by this author , and E. James WrightE. James Wright Baltimore, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1409AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bladder exstrophy is a congenital anomaly with defects in genitourinary tract and pelvic musculoskeletal system. It appears intuitive that closure of the pelvic ring with osteotomy will be associated with decreased risk of pelvic organ prolapse in this population. The aim of this study is to determine whether osteotomy is associated with a lower risk of pelvic organ prolapse in females with classic bladder exstrophy. METHODS We queried our institutional bladder exstrophy database, and identified 335 females. We excluded patients who were younger than 13 years old, those who had cloacal exstrophy or female epispadias, and those who had missing data. Our final study population consisted of 90 females. Univariate analysis was performed using t-test for continuous variables and chi-squared test for categorical variables. Logistic regression was used for multivariable analysis. RESULTS Median patient age was 20 years (range 13-60). Twenty-four patients (26.7%) developed pelvic organ prolapse at median age of 19 (range 11-43). Forty-five patients (50%) had undergone osteotomy at median age of 6 months (range birth to 16 years) and seven patients had at least one pregnancy (range 1-3 pregnancies). On univariate analysis (Table 1), only diastasis was significantly associated with prolapse, with smaller diastasis associated with lower risk of prolapse. On multivariable analysis including diastasis and osteotomy, only diastasis was statistically significant. Mean diastasis in patients who underwent osteotomy was 5.34 while for those who did not undergo osteotomy it was 7.72 (p =0.0013). Table 1. Logistic regression model to predict pelvic organ prolapse in patients with classic bladder exstrophy Prolapse No Prolapse P-value Diastasis (cm) 8.45(3.74) 5.7(2.67) 0.002 Osteotomy (%) 47.8 55.7 0.52 Age (years) 26.23(12.06) 22.49(10.54) 0.16 Pregnancies (%) 8.3 7.6 0.91 CONCLUSIONS Pelvic osteotomy does not appear to predict risk of pelvic organ prolapse in patients with classic bladder exstrophy. Rather, it is the degree of sympheseal diastasis that is significantly associated with pelvic organ prolapse. Table 2. Logistic regression model to predict pelvic organ prolapse in patients with classic bladder exstrophy Univariate analysis Multivariable analysis Variables OR(95%CI) p-value OR(95%CI) p-value Diastasis (cm) 1.32(1.09-1.60) 0.005 1.31(1.07-1.62) 0.01 Osteotomy (yes/no) 0.73(0.28-1.90) 0.52 0.89(0.25-3.21) 0.86 Age (years) 1.03(0.99-1.07) 0.16 - - Pregnancies(yes/no) 1.11(0.20-6.14) 0.91 - - © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e653 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ifeanyi Anusionwu Baltimore, MD More articles by this author Nima Baradaran Baltimore, MD More articles by this author Bruce Trock Baltimore, MD More articles by this author Andrew Stec Baltimore, MD More articles by this author John Gearhart Baltimore, MD More articles by this author E. James Wright Baltimore, MD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...