Pediatric Surgery and Urology Department, Nantes University Hospital, Nantes, France.
Pediatric Surgery and Orthopaedics Department, Nantes University Hospital, Nantes, France.
J Pediatr Surg. 2024 Sep;59(9):1841-1845. doi: 10.1016/j.jpedsurg.2024.03.058. Epub 2024 Apr 2.
Abdominal and pelvic closure remains a challenge during bladder exstrophy initial repair. We aimed to report on the feasibility and results of a novel technique of bilateral obturator osteotomy.
Retrospective study of prospective collected data of children who underwent single-stage delayed bladder exstrophy closure combined with RSTM (Radical Soft Tissue Mobilization) for BEEC (Bladder Exstrophy Epispadias Complex) by the same team at different institutions between December 2017 and May 2021. When pubic approximation was not feasible at the end of the procedure, bilateral obturator osteotomy was performed through the same approach, consisting in bilateral divisions of the ilio-pubic rami, ischio-pubic rami, obturator membrane, and detachment of the internal obturator muscle. Pubic bone fragments were approximated together on the midline. Immobilization in a thermoformed posterior splint was indicated for 3 weeks. The main outcome criterion was the bladder dehiscence rate at 6 months, assessed by physical inspection. Secondary outcome criteria included neurovascular obturator pedicle injury, analyzed during orthopedic physical examination, wound or bone infections, gait acquisition, reported by parents and evaluated during medical examination, and vascular penile impairment, judged by penile and glans coloration.
17 children (11 males, 6 females) were included, at a median age of 2 months [1-33]; and representing 29% (17/58) of the children with bladder exstrophy who underwent the same surgical approach during the time of study. There was no postoperative bladder dehiscence with a median follow-up of 34 months [6-47]. No complication was observed. Pelvic X-rays showed bilateral normal ossification process. Neither gait abnormality, nor clinical indication of obturator nerve deficiency was observed during follow-up.
When pubic bones approximation is not possible, bilateral obturator osteotomy is a useful adjunct in bladder exstrophy closure, feasible by the pediatric urologist through the same approach, and not requiring external fixator.
IV.
在膀胱外翻初始修复过程中，腹部和骨盆的关闭仍然是一个挑战。我们旨在报告一种新的双侧闭孔切开术的可行性和结果。
对 2017 年 12 月至 2021 年 5 月期间，由同一团队在不同机构对膀胱外翻会阴型患儿进行的一期延迟膀胱外翻关闭术和 RSTM（根治性软组织松解术）治疗 BEEC（膀胱外翻-会阴型尿道上裂复合畸形）前瞻性收集数据进行回顾性研究。当手术结束时耻骨无法接近时，通过相同的方法进行双侧闭孔切开术，包括双侧耻骨支、坐骨支、闭孔膜的切开，以及内收肌的分离。耻骨骨碎片在中线处靠拢。建议使用热成型后支具固定 3 周。主要观察指标是 6 个月时的膀胱裂开率，通过体格检查评估。次要观察指标包括神经血管闭孔蒂损伤，在骨科体格检查时分析，伤口或骨感染，步态获得，由家长报告并在体格检查时评估，以及阴茎血管损伤，通过阴茎和龟头颜色判断。
共纳入 17 例患儿（男 11 例，女 6 例），中位年龄 2 个月[1-33]；占研究期间接受相同手术方式治疗的膀胱外翻患儿的 29%（17/58）。在中位随访 34 个月[6-47]时，无术后膀胱裂开。无并发症发生。骨盆 X 线片显示双侧正常骨化过程。随访期间未观察到步态异常或闭孔神经功能缺损的临床指征。
当耻骨接近不可能时，双侧闭孔切开术是膀胱外翻关闭的一种有用的辅助方法，小儿泌尿科医生可以通过相同的方法进行，且无需外部固定器。
IV。
