Mp50-03 Staged vs Non-Staged Pelvic Osteotomies in the Modern Treatment of Cloacal Exstrophy: Bridging the Gap

You have accessJournal of UrologyPediatrics III (MP50)1 May 2024MP50-03 STAGED VS NON-STAGED PELVIC OSTEOTOMIES IN THE MODERN TREATMENT OF CLOACAL EXSTROPHY: BRIDGING THE GAP Ahmad Haffar, Alexander Hirsch, Chad Crigger, Nora Haney, Logan Galansky, Isam Nasr, Paul Sponseller, and John P. Gearhart Ahmad HaffarAhmad Haffar , Alexander HirschAlexander Hirsch , Chad CriggerChad Crigger , Nora HaneyNora Haney , Logan GalanskyLogan Galansky , Isam NasrIsam Nasr , Paul SponsellerPaul Sponseller , and John P. GearhartJohn P. Gearhart View All Author Informationhttps://doi.org/10.1097/01.JU.0001008684.57262.97.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Staged pelvic osteotomy has been shown in the past to be an effective tool in the closure of the wide pubic diastasis of cloacal exstrophy. The authors sought to compare orthopedic complications between non-staged and staged osteotomies in cloacal exstrophy. METHODS: An exstrophy-epispadias complex database of 1510 patients was reviewed for bladder closures in cloacal exstrophy performed with osteotomy at the authors' institution. Bladder closure failure was defined as fascial dehiscence, bladder prolapse, or vesicocutaneous fistula within one year of closure. RESULTS: 64 closure events fitting the inclusion criteria were identified in 61 unique patients. Staged osteotomy was performed in 42 closure events and non-staged in 22 closures. The mean diastasis for patients was 6.79 cm (Std dev=2.31 cm) with a median age at closure of 609 days (IQR=403–792 days). Complications occurred in 46/64 closure events, with 16 grade III/IV complications. There were no associations between staged osteotomy and overall complication or grade III/IV complications (p=0.6344 and p=0.1286, respectively). Of the 46 complications, 12 were orthopedic complications with 6 grade III/IV complications. Staged osteotomy closures experienced 10/42 orthopedic complications while non-staged closures experienced 2/22 orthopedic complications, however this did not reach significance (p=0.1519). There was no association between staged osteotomy and closure success overall (p=0.0686), but of the 52 primary closures, an association between staged osteotomy and successful closure was found (p=0.0241). Of the 64 closure events, 57 resulted in successful closure with 6 failures and one closure with planned cystectomy. CONCLUSIONS: This study confirms superior outcomes when using staged osteotomy in cloacal exstrophy bladder closure. Staged osteotomy was shown to be a safe alternative to non-staged osteotomy that can decrease the risk of closure failure. Staged osteotomy should be considered in all patients undergoing cloacal exstrophy bladder closure. Source of Funding: No source of funding © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e830 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Ahmad Haffar More articles by this author Alexander Hirsch More articles by this author Chad Crigger More articles by this author Nora Haney More articles by this author Logan Galansky More articles by this author Isam Nasr More articles by this author Paul Sponseller More articles by this author John P. Gearhart More articles by this author Expand All Advertisement PDF downloadLoading ...