A new osteotomy technique for the treatment of children with bladder exstrophy: a case series

BACKGROUND: Bladder exstrophy is a rare congenital urological anomaly affecting the bladder, genitalia, pelvic floor, and pelvic bones. Skeletal abnormalities associated with bladder exstrophy include external rotation of the iliac bones, shortening and hypoplasia of the pubic rami, and retroversion of the acetabulum. The main challenge in defect closure is pubic diastasis. AIM: The work aimed to present a novel pelvic osteotomy technique for the treatment of bladder exstrophy. METHODS: The study included 30 patients with classical bladder exstrophy who underwent pelvic osteotomy using the proposed technique. The cohort comprised 24 boys and 6 girls, aged from 1 day to 17 years, operated in various clinics in St. Petersburg (Russia), Tashkent (Uzbekistan), and Minsk (Belarus). RESULTS: After 30 surgical procedures for classical bladder exstrophy with pelvic osteotomy performed according to our technique in children aged from 1 day to 17 years, a complication occurred in only one case—postoperative wound infection—which was treated conservatively using broad-spectrum systemic antibiotics and local therapy. This complication occurred in the group of patients who underwent reoperation after prior surgical bladder repair without pelvic osteotomy. No patient developed an increase in pubic diastasis in the postoperative period. CONCLUSION: The proposed pelvic osteotomy technique is effective for abdominal wall closure and bladder reconstruction. This is confirmed by the low complication rate (3.3%), involving both orthopedic and urological aspects, as well as the absence of postoperative pubic diastasis in all patients. Moreover, this pelvic osteotomy technique is an effective procedure due to its excellent correction of the disrupted pelvic ring and preservation of this correction.