Pathology of the pelvic bones and its correction in bladder exstrophy

Abstract

There are many studies regarding treatment methods for bladder exstrophy, but it is impossible to single out the only correct one. When treating bladder exstrophy, all defects can be eliminated separately, but the effect of such interventions will be incomplete. When analyzing the anatomy of patients with this pathology, pronounced splitting and divergence of the pelvic muscles is noted due to dysplasia and the wide position of the iliac and pubic bones. Due to the inferiority of the pelvic bones, the functions of all its organs are disrupted. Modern methods of radiation research have made it possible to better understand the main causes of such changes: outwardly rotated iliac bones, retroversion of the acetabulum and femur, shortened branches of the pubic bones, a backward curved acetabulum and flabby sacroiliac joint, increased distance between the triradial cartilages. Such changes are difficult to eliminate with soft tissue plastic surgery, so specialists who use osteotomy of the pelvic bones in the treatment of this pathology have more positive results. Since 1958, in the treatment of children with exstrophy of the bladder, osteotomy has been used in various versions, which makes it possible to restore the pelvic ring, improve the results of soft tissue plastic surgery and urinary continence. The authors noted a high rate of continence success in patients who underwent primary bladder closure without complications such as wound infection, dehiscence, or any degree of bladder prolapse. Thus, correction of the skeletal system serves as a basic element in the correction of bladder exstrophy.