The failed bladder closure in cloacal exstrophy: Management and outcomes

Cloacal exstrophy (CE) is the most severe presentation of the Exstrophy-Epispadias Complex (EEC) and is associated with an omphalocele, making the bladder and abdominal wall closure difficult. If the bladder closure fails, a secondary closure is necessary. The objective of this study is to identify...

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Bibliographic Details
Published in:Journal of pediatric surgery 2019-11, Vol.54 (11), p.2416-2420
Main Authors: Davis, Rachel, Sood, Amol, Maruf, Mahir, Singh, Prachi, Kasprenski, Matthew C., DiCarlo, Heather N., Gearhart, John P.
Format: Article
Language:English
Subjects:
Anus, Imperforate - surgery
Bladder exstrophy
Bladder Exstrophy - surgery
Cloacal exstrophy
Epispadias - surgery
Female
Hernia, Umbilical - surgery
Humans
Infant
Infant, Newborn
Male
Osteotomy
Pediatric urology
Prognosis
Retrospective Studies
Scoliosis - surgery
Treatment Failure
Urogenital Abnormalities - surgery
Urologic Surgical Procedures
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Summary:Cloacal exstrophy (CE) is the most severe presentation of the Exstrophy-Epispadias Complex (EEC) and is associated with an omphalocele, making the bladder and abdominal wall closure difficult. If the bladder closure fails, a secondary closure is necessary. The objective of this study is to identify patient or surgical factors associated with a successful secondary closure. The institution's EEC database was reviewed for CE patients between 1975 and 2015. Inclusion criteria included a failed primary bladder closure with a secondary closure. Patient demographics, surgical factors and outcomes of the secondary bladder closure were reviewed. Twenty-four patients met inclusion criteria. 8/8 patients had a successful two-staged closure at the author's institution (100%); 2/16 patients had a successful closure at an outside institution (12.5%). Older median age at secondary closure was associated with outcome, p = 0.045. Pelvic osteotomy was associated with successful secondary closure, p = 0.013. Using Buck's immobilization with external fixation was associated with a higher proportion of successful secondary closures compared to Spica cast, p = 0.012. Successful reclosure in CE patients is associated with the use of osteotomy as well as Buck's immobilization with external fixation. While successful reclosure can be achieved, it is often at the cost of multiple procedures and, therefore, all efforts should be expended to achieve a successful primary closure. Type of Study: Prognostic. Level of Evidence: III.
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2019.02.012