The failed bladder closure in cloacal exstrophy: Management and outcomes
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In brief
In brief
This retrospective study of 24 cloacal exstrophy patients with failed primary bladder closure identifies key factors for successful secondary closure: pelvic osteotomy, Buck's immobilization with external fixation, and older age at reoperation. The two-staged approach at the authors' institution achieved 100% success versus 12.5% at outside centers.
Written by the GCMD Library team from the article.
Purpose
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.
Methods
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.
Results
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.
Conclusion
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.