Orthopaedic long term aspects of bladder exstrophy.

Abstract

This study evaluates long term orthopaedic aspects of children with bladder exstrophy who were operated on using different techniques and at different ages. Data were accumulated from 20 patients with an age range of 2 to 29 years (average, 13 years). Fourteen patients underwent pelvic osteotomy. Interviews and physical examinations confirmed that, in the long term, children with classical bladder exstrophy do not have significant orthopaedic problems or disability, whether or not they underwent pelvic osteotomy. Radiographic imaging showed normal hip joint configuration with marked pubic diastasis. There were no clinical problems associated with the diastasis. Pelvic computed tomography studies in 7 patients showed marked remodeling of the femora and acetabula. Radiographs of the spine showed a curve in 7 (47%) of the patients, but in only 3 cases was the curve larger than 10 degrees. Pelvic osteotomy is indicated during surgical correction of bladder exstrophy to facilitate closure of the abdominal wall to prevent postoperative wound dehiscence and possibly achieve better urinary control in older age. However, there is no clear indication for pelvic osteotomy from an orthopaedic point of view.