Pelvic osteotomy in the surgical treatment of extrophy of the bladder

Abstract

Introduction. Among combined congenital malformations one of the most difficult is bladder extrophy (BE), which is combined with a significant discrepancy of the pubic bones. Material and methods. We observed 12 children with BE in age from 1 to 14 years, the period of observation ranged from 1 to 10 years, while patients had a discrepancy pubic bones for a distance of more than 5 cm Treatment for 8 children was conducted after failed initial correction in different regions of Ukraine. Results. The treatment of children with extrophy must begin with the first day of a child’s life. The best option is a primary plastic of the bladder by local tissues with bilateral osteotomy of the pelvis. Our experience suggests that the disappearance of the pubic bones without osteotomy leads to prolapse of the bladder and recurrence of the defect, making it extremely difficult the subsequent treatment and minimizes the chances of the patient to the abilitation of the bladder. One of the main stages is a bilateral iliac osteotomy according to Salter and the formation symphysis of the pubic bones. The surgery is performed by two teams of surgeons, first performs orthopedic stage, and the urological team is create own or artificial bladder. After osteotomy, the distal fragments of the iliac bone rotated inward and downward, and in the pubic bones on both sides was introduced over the guide screw, which was subsequently used for the formation of pubic synostosis and fixing in contiguous position on a special plate. Iliac bone fragments were fixed by pins through the bone. Conclusion. The use of pelvic osteotomy allows to restore the anatomical relations of the urogenital diaphragm and the pelvic floor muscles that contributes to the retention of urine and feces, and thereby facilitates social rehabilitation of patients. Orthopedic stage of surgical rehabilitation of children with extrophy the key to the success of urological interventions and prevention of violations of gait due to elimination of external rotation of the lower limb and normalize pelvic balance.