Comparison of Musculoskeletal and Urological Functional outcomes in Patients with Bladder Exstrophy undergoing repair with and without osteotomy

Abstract

PURPOSE It is controversial whether osteotomy by restoring a more normal pelvic anatomy might improve the final outcome of bladder exstrophy (BE) repairs. We compared the functional orthopaedic and urological outcome in BE patients treated with and without osteotomy. MATERIAL AND METHODS Orthopaedic and urological outcome was compared in 8 BE patients treated with osteotomy and 6 BE patients treated without osteotomy. Orthopaedic evaluation included an assessment of pubic bones dissymmetry, bending of the spine, presence of Trendelemburg or Thomas sign, and presence of out-toeing. Pubic diastasis was ruled out with a plain x-ray of the pelvis. A Pediatric Orthopedic Society of North America (POSNA) questionnaire was administered to every child or his/her caregiver to assess functional outcome. Urological evaluation included an assessment of contemporary continence status and required continence surgery. RESULTS All patients presented a pubic diastasis. This was in median 49 (24 – 66) mm in patients treated without osteotomy and 42 (25 – 101) mm in those treated with osteotomy (p = 0.3). There was no difference either in the orthopaedic outcome or in any features of the POSNA questionnaire. Nor was there a difference in the final continence rate or in the number of additional continence procedures required. CONCLUSIONS Although osteotmy is an essential step in the treatment of many BE patients in order to achieve a tension-free closure of the bladder and the abdominal wall, our preliminary RESULTS suggest that it does not improve the eventual orthopaedic or urological outcome of BE.