The failed bladder closure in cloacal exstrophy: Management and outcomes.

Abstract

PURPOSE\nCloacal 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.\n\n\nMETHODS\nThe 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.\n\n\nRESULTS\nTwenty-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\u202f=\u202f0.045. Pelvic osteotomy was associated with successful secondary closure, p\u202f=\u202f0.013. Using Buck s immobilization with external fixation was associated with a higher proportion of successful secondary closures compared to Spica cast, p\u202f=\u202f0.012.\n\n\nCONCLUSION\nSuccessful 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.\n\n\nTYPE OF STUDY\nPrognostic.\n\n\nLEVEL OF EVIDENCE\nIII.