We have applied this method of approximation and internal fixation in pubic diastases as a biocompatible alternative to current metal fixation system with amenable imaging and tissue responses. This adds a layer of security to the pubic closure along with other current surgical armamentarium of bladder exstrophy. The key point was obtaining a persistent bony pelvis relationship restoration without inflammatory reaction and disturbance in bony growth. A reliable model was mandatory for this purpose. A major source of information concerning bladder exstrophy has come by the induction of an artificial exstrophy complex in animal models, or using naturally occurring classic bladder exstrophy in the animal population. Both techniques have considerable limitations for conducting a study to introduce new methods for anterior pelvic ring approximation; the high mortality in inducting the congenital anomaly in animals, and rarity of this birth defect, respectively. Additionally, such models are more useful in the assessment of embryologic development of exstrophy and proposing a possible role of mechanobiological stimulation of the bony pelvis in utero. In this regard, we used the symphysiotomy model. Considering the ongoing outward forces, on the separated pelvis, generated due to the quadric position of the animals, this model seems to be an acceptable representative of pubic diastasis in patients with bladder exstrophy. However, the rectangular shape of the pubis in goat may contribute to better fixation than human beings; our primary clinical results of biodegradable pubic fixation hold great promise. Editorial CommentUrologyVol. 75Issue 3PreviewThe pubic reapproximation that occurs at the end of a primary closure for exstrophy is the Achilles heel of the operation. This is true regardless of the technique used. The authors examine the use of a biodegradable plate to secure the pubic symphyses. This adds another layer of security to the closure and the biodegradable nature of the plate reduces the risk of later erosion and eliminates the need to remove it later. The results from this large animal study look promising. However, because no reproducible animal model for exstrophy exists, the successful use of a biodegradable plate in children who are undergoing exstrophy repair may be an entirely different affair. Full-Text PDF Editorial CommentUrologyVol. 75Issue 3PreviewThis is a novel method of bringing the pubic bones into apposition without the use of a metal plate. However, it suffers from 2 issues that must be addressed, which the authors have explained in their discussion. First, the pubis diastasis on average is 4 cm in the newborn with exstrophy, but can be > 6 cm in those with a large template (just the ones that you really want to work) and not simply separation of the pubis as in the model. Second, regardless of whatever material is used to bring the bones into apposition and whether or not osteotomy is used with or without fixation, they all separate with time. Full-Text PDF Editorial CommentUrologyVol. 75Issue 3PreviewCorrection of the pelvic diastasis in exstrophy helps minimize the tension on the closure and restore the integrity of the pelvic floor. This is done via pelvic approximation with or without osteotomy. The diastasis repair is typically held with suture or metal. This article attempts to solve problems of long immobilization and late effects of implants. The authors create a model of exstrophy by resecting a segment of the pubis in immature goats. By 3 months after surgery, the controls had a 21-mm diastasis, whereas the repaired group had only 4 mm. Full-Text PDF