RESUMEN
BACKGROUND: It has been posited that the osseous pelvic anomalies seen in patients with classic bladder exstrophy (CBE) result from disruption of the pubic symphysis. This hypothesis, however, has not been tested. In the present animal study, our objective was to determine whether the tension of the pubic symphysis helps maintain the shape of the pelvic ring, or whether the growing bones maintain a ring shape even without the tension of the symphysis. METHODS: In total, 12 neonatal New Zealand White rabbits underwent pubic symphysiotomy (experimental group, n=9) or sham surgery (control group, n=3) on days 3 or 4 of life. Rabbits were scanned with cone-beam computed tomography at 1, 4, 12, and 20 weeks postoperatively to monitor changes in the following pelvic parameters, which are known to be altered in CBE: anterior segment angle, anterior segment length, intertriradiate distance, interpubic distance, and posterior segment angle. Changes within the experimental and control groups were evaluated using repeated-measures analysis of variance and post hoc Tukey honest significant difference testing. Two-tailed t tests were used to compare treatment groups at each time point. RESULTS: Both groups showed increases in anterior segment length and intertriradiate distance during the study period; rabbits in the experimental group also showed a steady increase in interpubic distance (F=43.9; P<0.001). Experimental rabbits had significantly larger mean values for anterior segment angle, intertriradiate distance, interpubic distance, and posterior segment angle than did control rabbits at all time points. We found no difference in mean anterior segment length between control and experimental groups at any time point. The difference in interpubic distance was particularly pronounced by 20 weeks (experimental group, 13±2.7 mm; control group, 1.1±0.1 mm; P<0.001). CONCLUSIONS: The pubic symphysis is essential for normal pelvic development. Its absence led to early pelvic angulation and progressive pubic separation in a rabbit model. However, we found no significant difference in the mean anterior segment length, and it is likely that other factors are also implicated in the growth disturbance seen in CBE. LEVEL OF EVIDENCE: Level V.
Asunto(s)
Extrofia de la Vejiga/patología , Sínfisis Pubiana/anomalías , Animales , Animales Recién Nacidos , Modelos Animales de Enfermedad , Conejos , Distribución AleatoriaRESUMEN
Congenital prepubic sinus is a very rare urogenital anomaly that manifests as a tubular structure of varying histological findings that drains to the skin overlying the pubic symphysis. This tract has been observed to course above, below or, in only a handful of cases, directly through the pubis. We report a case of congenital prepubic sinus with this unusual transpubic course in an 18-year-old man. The patient was initially taken to the operating room for excision of a presumed inclusion cyst. At the time of surgery, the collection was found to track proximally and was excised down to the level of the pubic symphysis. Subsequent magnetic resonance (MR) imaging established the diagnosis of congenital prepubic sinus. We describe the different anatomical courses of congenital prepubic sinus, hypotheses of its pathogenesis, and the use of MR imaging in both diagnosis and surgical planning.
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Fístula Cutánea/diagnóstico por imagen , Imagen por Resonancia Magnética , Sínfisis Pubiana/anomalías , Anomalías Urogenitales/diagnóstico por imagen , Adolescente , Fístula Cutánea/cirugía , Humanos , Masculino , Anomalías Urogenitales/cirugíaRESUMEN
BACKGROUND: The decreased hip range of motion seen in femoroacetabular impingement syndrome (FAIS) may lead to compensatory increased motion at the symphysis pubis (SP) with resultant increased stress on the joint, which can subsequently lead to osteitis pubis. PURPOSE: To quantify the prevalence of SP abnormalities in patients with FAIS through the use of imaging modalities and to compare outcomes based on the presence of SP abnormalities. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Radiographs and magnetic resonance imaging (MRI) scans of 1009 consecutive patients who underwent primary hip arthroscopy for FAIS from January 2012 to January 2016 were identified. Exclusion criteria were patients undergoing revision or bilateral surgery, patients with dysplasia, and patients with less than 2-year follow-up. On radiographs, SP joints were reviewed for joint surface erosions, subchondral sclerosis and cysts, and ankylosis. MRI scans were reviewed for marrow edema in the subarticular pubic bone, subchondral sclerosis and cysts, joint surface erosions, and ankylosis. Patients with SP abnormalities were matched 1:2 to patients without SP abnormalities by age and body mass index. Outcomes included the Hip Outcome Score-Activities of Daily Living (HOS-ADL), HOS-Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), International Hip Outcome Tool-12 (iHOT-12), and visual analog scales (VAS) for pain and satisfaction. RESULTS: 830 patients were included; 23 (2.8%) demonstrated SP abnormalities. Of the 726 (72%) MRI scans reviewed, 15 (1.8%) showed bone marrow edema, subchondral sclerosis, erosions, or ankylosis. After matching, patients without SP abnormalities had significantly greater HOS-ADL (95.7 vs 83.0; P = .008), HOS-SS (91.6 vs 61.9; P = .003), iHOT-12 (89.5 vs 74.6; P = .046), and VAS satisfaction (91.3 vs 58.8; P = .004) scores, in addition to less postoperative pain (6.3 vs 23.5; P < .001). No significant differences were found in the mHHS (92.5 vs 82.2; P = .08). Patients without SP abnormalities had higher odds of achieving the minimal clinically important difference for the HOS-ADL (odds ratio [OR], 4.5; 95% CI, 1.3-14.1; P = .010), the HOS-SS (OR, 7.2; 95% CI, 1.8-18.5; P = .006), and the mHHS (OR, 14.5; 95% CI, 1.8-24.7; P = .013). CONCLUSION: A low prevalence (1.8%-2.6%) of SP joint abnormality is seen on imaging in patients with FAIS. These patients may demonstrate significantly inferior clinical outcomes and persistent postoperative pain after FAIS treatment.
Asunto(s)
Artroscopía/métodos , Pinzamiento Femoroacetabular/cirugía , Articulación de la Cadera/cirugía , Actividades Cotidianas , Adolescente , Adulto , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Diferencia Mínima Clínicamente Importante , Dolor/epidemiología , Satisfacción del Paciente , Prevalencia , Sínfisis Pubiana/anomalías , Rango del Movimiento Articular , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUÇÃO: O tratamento da região pubiana é parte integrante do reajuste corporal inferior nos pacientes pós-bariátricos, tendo em vista a fisiopatologia e o caráter generalizado das deformidades de contorno após grandes emagrecimentos. O objetivo é apresentar nossa experiência no tratamento de pacientes pós-bariátricos, exclusivamente pela marcação baixa da abdominoplastia com vetores adequados de mobilização tecidual, sem a necessidade de cicatrizes verticais ou oblíquas na região do púbis. MÉTODOS: Foram avaliados retrospectivamente prontuários médicos e registros fotográficos de pacientes submetidos a diferentes abordagens abdominais, com aplicação dos princípios descritos acima no tratamento associado da região pubiana. Incisão cutânea anterior baixa, descolamento cranial angulado em direção ao plano aponeurótico (bisel preservando gordura profunda superior), e manutenção um excedente gorduroso nos bordos superiores para a facilitar a fixação dos retalhos através do Sistema Fascial Superficial. Uma avaliação subjetiva da qualidade dos resultados foi caracterizada por observador único. RESULTADOS: Numa casuística de 126 pacientes consecutivos, a tática empregada possibilitou restabelecer a melhor posição, tônus e formato do púbis em 100% dos casos, cujos resultados foram subjetivamente classificados como bom (40%) ou ótimo (60%). As intercorrências mais frequentemente encontradas na evolução pós-operatória foram pequenas deiscências da sutura (23,8%) e seromas (19%), com boa evolução pelos curativos e punções seriadas. CONCLUSÃO: A tática cirúrgica apresentada, com posicionamento baixo da incisão anterior e aproximação dos retalhos por fixação no sistema fascial superficial e pele, possibilita o tratamento adequado da região pubiana durante as abdominoplastias pós-bariátricas, sem a necessidade de ressecções e cicatrizes adicionais.
INTRODUCTION: The treatment of the pubic region is an integral part of lower body readjustment in post-bariatric patients, considering the pathophysiology and generalized characteristics of contour deformities after a considerable weight loss. The objective is to present our experience in the treatment of post-bariatric patients, exclusively by low marking of abdominoplasty with appropriate tissue mobilization vectors, without the necessity to leave vertical or oblique scars in the pubic region. METHODS: The medical and photographic records of patients subjected to different abdominal approaches were retrospectively evaluated, applying the principles described above in the combined treatment of the pubic region. A low anterior skin incision was created, and angled cranial detachment towards the aponeurotic plane (with the bevel preserving the deep upper fat) and maintenance of excess fat on the upper edges to facilitate the fixation of the flaps through the superficial fascial system were performed. The outcomes' quality was subjectively evaluated by a single observer. RESULTS: In the case series of 126 consecutive patients, the strategy used restored the best position, tone, and shape of the pubis in 100% of the cases; the results were subjectively classified as good (40%) or very good (60%). The complications more frequently found in the post-operative period were small suture dehiscence (23.8%) and seroma formation (19%), with good evolution provided by dressings and serial punctures. CONCLUSION: The surgical strategy presented involving low positioning of the anterior incision and flap alignment in the superficial fascial system and skin by fixation allows the proper treatment of the pubic region during post-bariatric abdominoplasty procedures, without the need for additional resections and scars.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Historia del Siglo XXI , Sínfisis Pubiana/anomalías , Sínfisis Pubiana/cirugía , Peso Corporal , Cambios en el Peso Corporal , Obesidad Mórbida , Registros Médicos , Estudios Retrospectivos , Procedimientos de Cirugía Plástica , Cirugía Bariátrica , Sínfisis Pubiana , Obesidad Mórbida/cirugía , Obesidad Mórbida/complicaciones , Registros Médicos/normas , Procedimientos de Cirugía Plástica/efectos adversos , Procedimientos de Cirugía Plástica/métodos , Cirugía Bariátrica/efectos adversos , Cirugía Bariátrica/métodosRESUMEN
Introduction Abnormalities of the bony pelvis in exstrophy-epispadias complex (EEC) and their possible relation to hip disease are well described. However, there is a lack of information about long-term orthopedic consequences and hip function in patients with EEC. Therefore, we investigated clinical and radiological results in an EEC patient cohort after long-term follow-up. Patients and Methods We conducted a cross-sectional study using standardized radiography, clinical investigation, and the Harris hip score. Seventeen postpuberty consecutive unselected EEC patients (3 female, 14 male; mean age 18.2 years) that presented to our clinic due to urological procedures or routine check-up from 2010 to 2011 were included. All had undergone symphysis approximation with a traction bandage without osteotomy in early childhood. Radiological analysis was conducted offline by two independent investigators. Results Radiological analysis showed a mean pubic diastasis of 5.1 cm (range 2.8-8.5 cm). Borderline hip dysplasia was present in four patients, one of them having had co-occurring developmental hip dysplasia in previous history. No severe dysplasia, subluxation, or luxation of the hip was found; however, one patient showed early hip arthrosis. Clinical examination revealed no relevant restriction of range of motion, although rotation and abduction were slightly altered in five patients. None of the EEC patients complained about pain or restriction in sports or daily activities. Harris hip score was perfect for all but one study participants. Conclusion Despite EEC-specific hip morphology, long-term hip function is not impaired in patients after symphyseal approximation without osteotomy in the newborn period. The symphysis diastasis after this procedure is comparable to available postosteotomy data. The large majority of EEC patients did not show dysplastic or degenerative hip disease. Functional hip score results confirmed reasonable age-related hip function in nearly all examined patients. However, postnatal ultrasound hip screening is recommended to prevent and adequately treat potential co-occurring developmental hip dysplasia.
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Extrofia de la Vejiga/cirugía , Epispadias/cirugía , Articulación de la Cadera/fisiología , Huesos Pélvicos/anomalías , Sínfisis Pubiana/anomalías , Adolescente , Adulto , Extrofia de la Vejiga/complicaciones , Estudios Transversales , Epispadias/complicaciones , Femenino , Humanos , Recién Nacido , Masculino , Huesos Pélvicos/diagnóstico por imagen , Radiografía , Rango del Movimiento Articular , Tracción/métodos , Resultado del Tratamiento , Adulto JovenAsunto(s)
Neoplasias Óseas/diagnóstico , Isquion/anomalías , Osteocondrosis/diagnóstico , Tomografía de Emisión de Positrones/métodos , Sínfisis Pubiana/anomalías , Niño , Diagnóstico Diferencial , Femenino , Fluorodesoxiglucosa F18 , Humanos , Isquion/patología , Pronóstico , Sínfisis Pubiana/patología , Radiofármacos , Tomografía Computarizada por Rayos X/métodosRESUMEN
The symphysis pubis is demonstrated on many conventional radiographic and cross-sectional examinations and abnormality of the symphysis pubis is a common imaging finding with numerous possible causes. Many significant disorders that affect the symphysis pubis cause it to appear widened, eroded, or destroyed on imaging studies. It is useful for radiologists to have a working differential diagnosis for these appearances, to use when reporting such studies. This review briefly describes the anatomy of the symphysis pubis and presents examples of the various developmental, inflammatory, infectious, neoplastic, traumatic, and metabolic disorders that may cause it to become widened, eroded, or destroyed. Some disorders have pathognomonic imaging features. Others give rise to similar findings that depend more on overall disease activity, rather than the specific diagnosis itself. In such cases, correlation with clinical and laboratory findings will help narrow the differential diagnosis.
Asunto(s)
Imagen por Resonancia Magnética/métodos , Diástasis de la Sínfisis Pubiana/diagnóstico por imagen , Sínfisis Pubiana/diagnóstico por imagen , Sínfisis Pubiana/fisiopatología , Tomografía Computarizada por Rayos X/métodos , Adulto , Factores de Edad , Anciano , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/patología , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteítis/diagnóstico por imagen , Osteítis/fisiopatología , Sínfisis Pubiana/anomalías , Medición de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Adulto JovenRESUMEN
BACKGROUND: Bladder extrophy malformation includes outward rotation of the innominate bones, pubic symphysis diastasis and acetabular retrovertion. We have corrected the pelvic deformation during the reconstruction of the bladder neck and the urethra in older children. METHODS: From 1/01/2002 to 1/01/2006 in the Department of Pediatric Urology and the Department of Pediatric Orthopedics in Katowice 4 children were operated on for bladder extrophy. The age of the patients ranged from 2.3 to 4.1 years; an average of 3.6 years. In the patients with bladder extrophy we performed the urological reconstruction and simultaneously the bilateral Salter's osteotomy was done. RESULTS: The follow up was 52 months (48-84).The consolidation of the osteotomy was obtained in all patients after 62 days (48-72) with the correction of the retroversion of the hips and symphysis to 2.4 cm (0.9-5.8). CONCLUSION: The innominate Salter's osteotomy is helpful in the bladder neck reconstruction and allows to achieve the proper anatomy of the pelvic ring.
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Extrofia de la Vejiga/cirugía , Osteotomía/métodos , Huesos Pélvicos/cirugía , Sínfisis Pubiana/cirugía , Preescolar , Femenino , Humanos , Ilion/anomalías , Ilion/cirugía , Masculino , Huesos Pélvicos/anomalías , Polonia , Sínfisis Pubiana/anomalías , Resultado del Tratamiento , Procedimientos Quirúrgicos Urológicos/métodosRESUMEN
A pubalgia é uma síndrome caracterizada por processo inflamatório da sínfise púbica, predominante em esportes que envolvem esforços repetitivos com freqüentes mudanças de direção e arranques, como o futebol e o tênis. Os sintomas são freqüentemente inespecíficos e de difícil diagnóstico. Desta forma, proporcionam longos períodos de afastamento de atividades físicas e esportivas, perpetuando os desequilíbrios funcionais e dificultando o tratamento. A pubalgia pode ser tratada de três formas: preventiva, conservadora, ou cirúrgica. O estudo teve como objetivo propor um protocolo de tratamento preventivo de pubalgia, para prevenir desequilíbrios da musculatura da cintura pélvica. Participaram do presente estudo 13 atletas de futsal do sexo masculino, com idade média de 18 anos, da equipe sub-20 do Sport Club Corinthians Paulista. Todos foram submetidos a duas avaliações, inicial e final, e ao protocolo de tratamento preventivo realizado duas vezes por semana por período de dois meses. Os resultados demonstraram uma melhora de flexibilidade e do fortalecimento da musculatura abdominal nos jogadores. Assim, pode-se concluir que o protocolo se mostrou eficaz na melhora da flexibilidade e do fortalecimento da musculatura abdominal.
The pubic pain is a syndrome characterized by an inflammatory process of pubic symphysis. It is predominant in sports that use repetitive efforts with different changes in direction such as football and tennis. The symptoms are not frequently specific and the disease is difficult to diagnose. Therefore, long periods of absence from physical activities imply in difficulties in treatment. The pubic pain can be treated in three different ways: preventive, conservative or surgical. This study aimed at conducting a treatment and preventive protocol for preventing imbalances of pelvic muscles. Thirteen male athletes of futsal, average age 18 years, from the sub 20 team from the Sport Club Corinthians Paulista participated to the study. All of them were submitted to two evaluations, at the beginning and at the end, and to treatment and preventive protocol carried out twice a week for two months. The results showed improving in flexibility and stretching of players abdominal muscles. We can conclude that the protocol was effective to improve flexibility and abdominal muscles strengthening.
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Ejercicio Físico , Docilidad , Sínfisis Pubiana/anomalías , Sínfisis Pubiana/lesiones , Sínfisis Pubiana/patología , Diafragma Pélvico , Diafragma Pélvico/lesionesAsunto(s)
Extrofia de la Vejiga/diagnóstico por imagen , Anomalías Congénitas/diagnóstico por imagen , Traumatismo Múltiple/diagnóstico por imagen , Huesos Pélvicos/lesiones , Accidentes de Tránsito , Adulto , Extrofia de la Vejiga/diagnóstico , Anomalías Congénitas/diagnóstico , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Hallazgos Incidentales , Puntaje de Gravedad del Traumatismo , Traumatismo Múltiple/cirugía , Huesos Pélvicos/cirugía , Sínfisis Pubiana/anomalías , Radiografía , Medición de RiesgoRESUMEN
OBJECTIVE: To present the early results of pelvic osteotomies performed for repair of exstrophy bladder. METHODS: Five cases of exstrophy bladder were treated with closure following bilateral iliac osteotomies. Three patients underwent closure of pubic symphysis diastasis by use of external fixator, one by screws and cerclage wires, and one by use of K-wires and suture. The patients were followed up by the pediatric urologist and orthopedic surgeon. RESULTS: All patients achieved a closure of diastasis and a tension free repair after the index surgery. The average follow-up was 3.6 years with range of 4 months to 6 years. All osteotomies healed within two months and had closure of the diastasis, except one which had a partial failure with loss of 50% correction. No patient had any wound dehiscence or breakdown of the bladder repair. Preoperative mean diastasis of symphysis pubis was 6 cm (range; 4.5 cm to 7 cm) and post operative mean diastasis was 3.5 cm with the range of 2.5 cm to 4 cm at 12 months follow up. All patients achieved urinary continence post operatively and were passing urine per-urethra with satisfactory urinary control as followed-up with the pediatric urologists. CONCLUSION: Bilateral iliac osteotomies and use of external fixator in our series was found to be helpful in achieving a tension free closure and preventing dehiscence of the repair.
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Extrofia de la Vejiga/cirugía , Fijadores Externos , Osteotomía/métodos , Huesos Pélvicos/cirugía , Procedimientos Quirúrgicos Urológicos/métodos , Adulto , Niño , Preescolar , Femenino , Humanos , Ilion/anomalías , Ilion/diagnóstico por imagen , Ilion/cirugía , Lactante , Masculino , Osteotomía/instrumentación , Huesos Pélvicos/anomalías , Huesos Pélvicos/diagnóstico por imagen , Sínfisis Pubiana/anomalías , Sínfisis Pubiana/cirugía , Radiografía , Estudios Retrospectivos , Procedimientos Quirúrgicos Urológicos/instrumentaciónRESUMEN
The expansion of the pubic symphysis during pregnancy in some rodet depends on the growth of the interpubic ligament, primarily through the biosynthesis of extracellular matrix. Although there is a significant metabolism of elastin in the female reproductive tract during pregnancy, little is known of the architectural and ultrastructural aspects of the elastic system fibers in the mouse pubic symphysis. In this study, the main characteristics of the elastic system of the mouse pubic symphysis during pregnancy, partum and post-partum were determined by light and electron microscopy. A distinct arrangement of microfibrils, elastin deposition and development of the extracellular matrix formed a supporting framework that uniformly distributed stress in order to provide adequate interpubic resilience during delivery. These changes support a role for elastic system fibers in symphyseal maturation and reconstruction during pregnancy and after delivery.
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Animales , Embarazo , Ratas , Microscopía Electrónica/métodos , Fibras Musculares Esqueléticas , Sínfisis Pubiana/anatomía & histología , Sínfisis Pubiana/anomalías , Sínfisis Pubiana/ultraestructuraAsunto(s)
Extrofia de la Vejiga/diagnóstico , Epispadias/diagnóstico , Adulto , Diagnóstico Diferencial , Humanos , Recién Nacido , Riñón/anomalías , Masculino , Sínfisis Pubiana/anomalías , Recto del Abdomen/anomalías , Ultrasonografía , Vejiga Urinaria/anomalías , Vejiga Urinaria/patología , UrografíaRESUMEN
One-stage combined surgery in a female patient with total extrophy of the urinary bladder after uretherosigmostomy was performed for the first time with participation of surgeons, gynecologists and urologists. Corrective surgeries in these patients must be performed for the purpose of creation of isolated urinary reservoir for prophylaxis of pyelonephritis and chronic renal insufficiency. Correction of symphysis defect was carried out with polypropylene endograft. This surgery was performed to provide quality of life and reproductive function of the patient.
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Genitales Femeninos/anomalías , Genitales Femeninos/cirugía , Procedimientos Quirúrgicos Ginecológicos/métodos , Sínfisis Pubiana/cirugía , Vejiga Urinaria/cirugía , Adulto , Femenino , Humanos , Polipropilenos , Sínfisis Pubiana/anomalías , Pielonefritis/prevención & control , Calidad de Vida , Reproducción , Vejiga Urinaria/anomalíasRESUMEN
PURPOSE: Radiographic abnormalities in the pubic bone and symphysis are often seen in athletes with groin pain. The aim was to create a grading scale of such radiologic changes. MATERIAL AND METHODS: Plain radiography of the pelvic ring including the pubic bone and the symphysis was performed in 20 male athletes, age 19-35, with long-standing uni- or bilateral groin pain. We used two control groups: Control group 1: 20 healthy age-matched men who had undergone radiologic examination of the pelvis due to trauma. Control group 2: 120 adults (66 men and 54 women) in 9 age groups between 15 and 90 years of age. These examinations were also evaluated for interobserver variance. RESULTS AND CONCLUSION: The grading scale was based on the type and the amount of the different changes, which were classified as follows: No bone changes (grade 0), slight bone changes (grade 1), intermediate changes (grade 2), and advanced changes (grade 3). The grading scale is easy to interpret and an otherwise troublesome communication between the radiologist and the physician was avoided. There was a high interobserver agreement with a high kappa value (0.8707). Male athletes with long-standing groin pain had abnormal bone changes in the symphysis significantly more frequently and more severely (p>0.001) than their age-matched references. In asymptomatic individuals such abnormalities increased in frequency with age both in men and women.
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Dolor/clasificación , Dolor/diagnóstico por imagen , Hueso Púbico/anomalías , Hueso Púbico/diagnóstico por imagen , Sínfisis Pubiana/anomalías , Sínfisis Pubiana/diagnóstico por imagen , Radiografía/clasificación , Deportes , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor/etiología , Dimensión del Dolor , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores de TiempoRESUMEN
BACKGROUND: Classic bladder exstrophy is a developmental defect presenting at birth with a wide pubic separation and an exposed bladder; cloacal exstrophy involves, in addition, intestinal prolapse. Reconstruction requires several surgical procedures. The use of anterior iliac osteotomies in this process has not been reviewed in a large series. METHODS: We reviewed the results of eighty-six anterior innominate osteotomies performed in conjunction with genitourinary repair of classic and cloacal bladder exstrophy in eighty-two patients. Clinical outcome measures were successful bladder closure, achievement of continence, and maintenance of a normal gait. Radiographs of the pelvis were reviewed, and the pubic intersymphyseal diastasis (a measure of the reduction in tension on the anterior closure) was measured preoperatively and at three time-points postoperatively. Children with classic exstrophy who had undergone osteotomy and bladder neck reconstruction but not bladder augmentation were divided into four groups on the basis of the degree of continence. In addition, children with classic exstrophy were stratified according to age at the time of the osteotomy. The mean postoperative percent reduction in the amount of the original diastasis was determined for all groups. RESULTS: Children with classic exstrophy and those with cloacal exstrophy had correction of the diastasis after the osteotomy, with greater correction in those with classic exstrophy, presumably because of better bone quality. Daytime continence was achieved with anterior osteotomy and bladder neck reconstruction in 74% of the children for whom continence was a goal. However, no difference in the symphyseal diastasis or in the percentage of pubic reduction was detected among the four continence groups. Children who were older at the time of the osteotomy maintained better correction over time. Wound dehiscence or bladder prolapse occurred in 4% of the patients who had osteotomy and primary closure, and the only important complication of the osteotomies was transient palsy of the left femoral nerve in seven children. CONCLUSIONS: Anterior innominate osteotomy is an effective part of reconstructive repair of bladder exstrophy. The primary goals of the osteotomy are to reduce the tension in the closed bladder and the lower abdominal wall and to promote continence by restoring the sling of the pelvic floor muscles. These goals can be achieved in the majority of patients.
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Extrofia de la Vejiga/cirugía , Ilion/cirugía , Osteotomía/métodos , Huesos Pélvicos/anomalías , Adolescente , Factores de Edad , Extrofia de la Vejiga/complicaciones , Extrofia de la Vejiga/diagnóstico por imagen , Niño , Preescolar , Femenino , Marcha , Humanos , Ilion/anomalías , Ilion/diagnóstico por imagen , Lactante , Recién Nacido , Masculino , Huesos Pélvicos/diagnóstico por imagen , Huesos Pélvicos/cirugía , Complicaciones Posoperatorias , Sínfisis Pubiana/anomalías , Sínfisis Pubiana/diagnóstico por imagen , Sínfisis Pubiana/cirugía , Radiografía , Estudios Retrospectivos , Incontinencia Urinaria/etiología , Incontinencia Urinaria/cirugíaRESUMEN
The characteristic of duplicated exstrophy is the presence of a patch of exstrophic bladder mucosa in the infraumbilical region with a low-set umbilicus, in addition to the normal bladder. Musculoskeletal defects, diastasis pubis, and rectus abdominis can also be found in these patients. We report the first case of a female twin baby with appearance of a low-set umbilicus and diastasis pubis associated with a pubic sinus. The external genitalia and urinary continence were normal. Duplicated exstrophic mucosal remnant was excised, and the histopathologic study of the specimen confirmed urothelium.
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Extrofia de la Vejiga/diagnóstico , Enfermedades en Gemelos/diagnóstico , Anomalías Múltiples/diagnóstico , Anomalías Múltiples/genética , Anomalías Múltiples/cirugía , Extrofia de la Vejiga/genética , Extrofia de la Vejiga/cirugía , Enfermedades en Gemelos/genética , Femenino , Humanos , Recién Nacido , Pronóstico , Sínfisis Pubiana/anomalías , Sínfisis Pubiana/cirugía , Gemelos MonocigóticosRESUMEN
A rare exstrophy variant in a 1(1/2)-year-old girl is reported. The child had a wide, scar-like lesion over the lower central abdomen with divarication of the recti and a spread symphysis pubis. The underlying bladder was divided into two unequal chambers by a complete sagittal septum with only the right chamber communicating with the single urethra and the left draining by a vesicocutaneous fistula. Both kidneys were normal. The clitoris was bifid and the anus anteriorly placed. Preliminary surgical management consisted of dissection of the bladder from its prevesical covering, excision of the sagittal septum, and cystocystostomy. Postoperatively, the child had normal urinary continence. The literature is reviewed with special reference to the various forms of duplicate exstrophy.