Predictors of a successful primary bladder closure in cloacal exstrophy: A multivariable analysis
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In brief
In brief
Multivariable analysis of 99 cloacal exstrophy patients demonstrates that staged surgical approach and pelvic osteotomy independently predict successful primary bladder closure, with osteotomy increasing success odds six-fold. Study strongly recommends combining staged approach with osteotomy for optimal reconstructive outcomes in this complex congenital anomaly.
Written by the GCMD Library team from the article.
Purpose
To investigate the factors affecting primary bladder closure in cloacal exstrophy (CE). A successful primary closure is important for optimizing reconstructive outcomes, and it is a critical first-step in the reconstruction of CE. The authors' hypothesize that a smaller diastasis and use of an osteotomy are independent predictors of a successful closure.
Methods
A prospectively maintained database of 1332 exstrophy-epispadias complex (EEC) patients was reviewed for CE patients closed between 1975 and 2015. Univariate and multivariable analyses were performed to identify significant factors associated with CE primary bladder closure.
Results
Of 143 CE patients identified, 99 patients met inclusion criteria. Median follow-up time was 8.82 [IQR 5.43–14.26] years. In the multivariable model, the odds of having a successful closure are about 4 times greater for the staged cloacal approach compared to the 1-stage approach (OR, 3.7; 95% CI 1.2–11.5; p-value = 0.023). Also, having an osteotomy increases the chance of a successful closure by almost six-fold (OR, 5.8; 95% CI 1.7–19.6; p-value = 0.004).
Conclusions
Using the staged approach with a pelvic osteotomy is paramount to a successful primary closure in CE. The authors strongly recommend using the staged approach and osteotomy as these factors independently increase the chance for a successful primary bladder closure.
Study Type
Therapeutic study.
Level of Evidence
Level III, Retrospective comparative study.