Pathology of the pelvic bones and its correction in bladder exstrophy

Abstract

There are many studies regarding treatment methods for bladder exstrophy, but it is impossible to single out the only correct one. When treating bladder exstrophy, all defects can be eliminated separately, but the effect of such interventions will be incomplete. When analyzing the anatomy of patients with this pathology, pronounced splitting and divergence of the pelvic muscles is noted due to dysplasia and the wide position of the iliac and pubic bones. Due to the inferiority of the pelvic bones, the functions of all its organs are disrupted. Modern methods of radiation research have made it possible to better understand the main causes of such changes: outwardly rotated iliac bones, retroversion of the acetabulum and femur, shortened branches of the pubic bones, a backward curved acetabulum and flabby sacroiliac joint, increased distance between the triradial cartilages. Such changes are difficult to eliminate with soft tissue plastic surgery, so specialists who use osteotomy of the pelvic bones in the treatment of this pathology have more positive results. Since 1958, in the treatment of children with exstrophy of the bladder, osteotomy has been used in various versions, which makes it possible to restore the pelvic ring, improve the results of soft tissue plastic surgery and urinary continence. The authors noted a high rate of continence success in patients who underwent primary bladder closure without complications such as wound infection, dehiscence, or any degree of bladder prolapse. Thus, correction of the skeletal system serves as a basic element in the correction of bladder exstrophy.

Keywords

bladder exstrophy / pelvic osteotomy

References

[1] Kahnici Gokhan. Insights from sumerian mythology: The myth of Enki And Ninmaḫ and the history of disability. Tarih İncelemeleri Dergisi. 2018;33/2:429–450. DOI: 10.18513/egetid.502714.

[2] Buyukunal CS, Gearhart JP. A short history of bladder exstrophy. Semin Pediatr Surg. 2011;20(2):62–65. DOI: 10.1053/j.sempedsurg.2011.01.004.

[3] Jarosz SL, Weaver JK, Weiss DA, Borer JG, Kryger JV, Canning DA, Groth TW, Lee T, Shukla AR, Mitchell ME, Roth EB. Bilateral ureteral reimplantation at complete primary repair of exstrophy: Post-operative outcomes. J Pediatr Urol. 2022;18(1):37.e1–37.e5. DOI: 10.1016/j.jpurol.2021.10.012.

[4] Varma KK, Mammen A, Kolar Venkatesh SK. Mobilization of pelvic musculature and its effect on continence in classical bladder exstrophy: A single-center experience of 38 exstrophy repairs. J Pediatr Urol. 2015;11(2):87.e1–87.e5. DOI: 10.1016/j.jpurol.2014.11.023.

[5] Khabibyanov RYa, Andreyev PS, Akramov NR, Kadyrov AA. Surgical restoration of a pelvic ring in congenital abnormality — extrophy of bladder. Prakticheskaya meditsina. 2017;(8):154–156. (In Russ.)

[6] Хабибьянов Р.Я., Андреев П.С., Акрамов Н.Р., Кадыров А.А. Хирургическое восстановление тазового кольца при врождённой аномалии развития — экстрофии мочевого пузыря. Практическая медицина. 2017;(8):154–156. EDN: ZHVGAF.

[7] Petrarca M, Zaccara A, Marciano A, Della Bella G, Mosiello G, Carniel S, Gazzellini S, Capitanucci ML, De Gennaro M, Caione P, Aloi IP, Castelli E. Gait analysis in bladder exstrophy patients with and without pelvic osteotomy: A controlled experimental study. Eur J Phys Rehabil Med. 2014;50(3):265–274. PMID: 24651208.

[8] Nhan DT, Sponseller PD. Bilateral anterior innominate osteotomy for bladder exstrophy. JBJS Essent Surg Tech. 2019;9(1):e1. DOI: 10.2106/JBJS.ST.18.00018.

[9] Suson KD, Sponseller PD, Gearhart JP. Bony abnormalities in classic bladder exstrophy: The urologist’s perspective. J Pediatr Urol. 2013;9(2):112–122. DOI: 10.1016/j.jpurol.2011.08.007.

[10] Lee T, Borer J. Exstrophy-epispadias complex. Urol Clin North Am. 2023;50(3):403–414. DOI: 10.1016/j.ucl.2023.04.004.

[11] Ptitsyna OA, Leonenko TV, Krutskikh EL, Nekrasova II. Bladder exstrophy (clinical case). Mnogoprofilnyy statsionar. 2018;5(1):19–21. (In Russ.)

[12] Птицына О.А., Леоненко Т.В., Крутских Е.Л., Некрасова И.И. Экстрофия мочевого пузыря (клинический случай). Многопрофильный стационар. 2018;5(1):19–21. EDN: ARPHAS.

[13] Rashitov LF, Akhunzyanov AA, Zakirova AM, Takhautdinov ShK. Short clinico-anatomo-topographic description of extrophy development defects in children. Pediatric and adolescent reproductive health. 2009;(1):62–69. (In Russ.)

[14] Рашитов Л.Ф., Ахунзянов А.А., Закирова А.М., Тахаутдинов Ш.К. Краткая клинико-анатомо-топографическая характеристика экстрофийных пороков развития у детей. Репродуктивное здоровье детей и подростков. 2009;(1):62–69. EDN: KXYYFD.

[15] Ramji J, Eftekharzadeh S, Fischer KM, Joshi RS, Reddy PP, Pippi-Salle JL, Frazier JR, Weiss DA, Canning DA, Shukla AR. Variant of bladder exstrophy with an intact penis: Surgical options and approach. Urology. 2021;149:e15–e17. DOI: 10.1016/j.urology.2020.11.046.

[16] Hamdy MH, El-Kholi NA, El-Zayat S. Incomplete exstrophy of the bladder. Br J Urol. 1988;62(5):484–485. DOI: 10.1111/j.1464-410X.1988.tb04399.x.

[17] Agbara KS, Moulot OM, Ehua MA, Konan JM, Yapo Kouamé GS, Traoré I, Anon GA, Ajoumissi I, Konvolbo J, Bankolé RS. Bladder exstrophy: Modern staged repair experience in our institution. Afr J Paediatr Surg. 2022;19(3):167–170. DOI: 10.4103/ajps.AJPS_167_20.

[18] Sarin YK, Sekhon V. Exstrophy bladder — reconstruction or diversion for the underprivileged. Indian J Pediatr. 2017;84(9):715–720. DOI: 10.1007/s12098-017-2419-9.

[19] Pathak P, Ring JD, Delfino KR, Dynda DI, Mathews RI. Complete primary repair of bladder exstrophy: A systematic review. J Pediatr Urol. 2020;16(2):149–153. DOI: 10.1016/j.jpurol.2020.01.004.

[20] Gómez González B, Hevia Feliú A, Serralta de Colsa D, Salinas Moreno S, González-Valcarcel de Torres I, De la Morena Gallego JM. Synchronous enteroid adenocarcinoma at the ureteral implantation site after ureterosigmoidostomy. Urol Case Rep. 2022;45:102225. DOI: 10.1016/j.eucr.2022.102225.

[21] Wilhelm TJ, Knoll T, Weisser G, Grobholz R, Köhrmann KU, Post S. Urothelial carcinoma of the ureter, giant rectal stone and sigmoid carcinoma 55 years after ureterosigmoidostomy. Scand J Urol Nephrol. 2006;40(2):172–173. DOI: 10.1080/00365590600688419.

[22] Zimmer V, Lammert F. Ureterosigmoidostomy. Dig Liver Dis. 2019;51(11):1618. DOI: 10.1016/j.dld.2019.08.026.

[23] Coffey RC. Transplantation of the ureters: for cancer of the bladder with cystectomy. Ann Surg. 1930;91(6):908–923. DOI: 10.1097/00000658-193006000-00010.

[24] Leadbetter WF. Consideration of problems incident to performance of uretero-enterostomy: Report of a technique. J Urol. 1951;65:818. DOI: 10.1016/S0022-5347(17)68556-2.

[25] Nesterov PV, Ukharskiy AV, Gurin EV, Metelkova EA. Uretero-intestinal anastomoses: which method to choose? History, current state of the issue and own experience. Eksperimentalnaya i klinicheskaya urologiya. 2021;14(1):108–113. (In Russ.) DOI: 10.29188/2222-8543-2021-14-1-108-113.

[26] Нестеров П.В., Ухарский А.В., Гурин Э.В., Метелькова Е.А. Мочеточнико-кишечные анастомозы: какой метод выбрать? История, современное состояние вопроса и собственный опыт. Экспериментальная и клиническая урология. 2021;14(1):108–113. DOI: 10.29188/2222-8543-2021-14-1-108-113.

[27] Wild AT, Sponseller PD, Stec AA, Gearhart JP. The role of osteotomy in surgical repair of bladder exstrophy. Semin Pediatr Surg 2011;20(2):71e8. DOI: 10.1053/j.sempedsurg.2010.12.002.

[28] Wongcharoenwatana J, Adulkasem N, Ariyawatkul T, Eamsobhana P, Chotigavanichaya C, Chotivichit A. A long-term outcome (up to 29 years) of bilateral iliac wings “bayonet osteotomies” for closure of bladder exstrophy. J Orthop Surg Res. 2023;18(1):329. DOI: 10.1186/s13018-023-03810-9.

[29] Trendelenburg F. De la cure operatoire de l’exstrophie vesicale et de l’epispadias. Arch Klin Chir. 1892;43:394.

[30] Trendelenburg F. XIII. The Treatment of Ectopia Vesicae. Ann Surg. 1906;44(2):281–289. DOI: 10.1097/00000658-190608000-00013.

[31] Passavant G. Vesico-urethral suture and uniting of the symphysic fissure for congenital exstrophy of the bladder with epispadias. Ann Surg. 1888;7:306–308.

[32] Luk L, Taffel MT. Cross-sectional anatomy of the male pelvis. Abdom Radiol (NY). 2020;45(7):1951–1960. DOI: 10.1007/s00261-019-02369-6.

[33] Rocca Rossetti S. Functional anatomy of pelvic floor. Arch Ital Urol Androl. 2016;31(88(1)):28–37. DOI: 10.4081/aiua.2016.1.28.

[34] Flusberg M, Kobi M, Bahrami S, Glanc P, Palmer S, Chernyak V, Kanmaniraja D, El Sayed RF. Multimodality imaging of pelvic floor anatomy. Abdom Radiol (NY). 2021;46(4):1302–1311. DOI: 10.1007/s00261-019-02235-5.

[35] Tekes A, Ertan G, Solaiyappan M, Stec AA, Sponseller PD, Huisman TA, Gearhart JP. 2D and 3D MRI features of classic bladder exstrophy. Clin Radiol. 2014;69(5):e223–e229. DOI: 10.1016/j.crad.2013.12.019.

[36] De Mattos CB, Mendes PH, Boechat PR, Júnior JL, da Silva Guimarães L. Bilateral anterior pelvic osteotomy for closure of bladder exstrophy: Description of technique. Rev Bras Ortop. 2015;46(1):107–113. DOI: 10.1016/S2255-4971(15)30187-7.

[37] Stec AA, Pannu HK, Tadros YE, Sponseller PD, Wakim A, Fishman EK, Gearhart JP. Evaluation of the bony pelvis in classic bladder exstrophy by using 3D-CT: Further insights. Urology. 2001;58(6):1030–1035. DOI: 10.1016/s0090-4295(01)01355-3.

[38] Mabille M, De Laveaucoupet J, Senat MV, Picone O, Levaillant JM, Mas AE, Musset D. Imaging of the fetal bony pelvis by computed tomography in a case of bladder exstrophy. Ultrasound Obstet Gynecol. 2009;33(6):716–719. DOI: 10.1002/uog.6409.q.

[39] Rudin YuE, Marukhnenko DV, Chekeridi YuE, Rassovsky SV, Runenko VI. Sposoby korrektsii ekstrofii mochevogo puzyrya u detey. Russian journal of pediatric surgery. 2009;(4):18–22. (In Russ.)

[40] Рудин Ю.Э., Марухненко Д.В., Чекериди Ю.Э., Рассовский С.В., Руненко В.И. Способы коррекции экстрофии мочевого пузыря у детей. Детская хирургия. 2009;(4):18–22. EDN: KXDDOL.

[41] Hammouda HM, Shahat AA, Oyoun NA, Safwat AS, Elderwy AA, Elgammal MA. Long term evaluation of continence after complete primary bladder exstrophy repair. J Pediatr Urol. 2023;20:1477-5131(23)00315-7. DOI: 10.1016/j.jpurol.2023.08.001.

[42] Castagnetti M, Gigante C, Perrone G, Rigamonti W. Comparison of musculoskeletal and urological functional outcomes in patients with bladder exstrophy undergoing repair with and without osteotomy. Pediatr Surg Int. 2008;24:689–693. DOI: 10.1007/s00383-008-2132-x.

[43] Davis R, Maruf M, Dunn E, Di Carlo H, Gearhart JP. The role of anatomic pelvic dissection in the successful closure of bladder exstrophy: An aid to success. J Pediatr Urol. 2019;15(5):559.e1–559.e7. DOI: 10.1016/j.jpurol.2019.06.025.

[44] Baka-Ostrowska M, Kowalczyk K, Felberg K, Wawer Z. Complications after primary bladder exstrophy closure — role of pelvic osteotomy. Cent European J Urol. 2013;66(1):104–108. DOI: 10.5173/ceju.2013.01.art31.

[45] Kantor R, Salai M, Ganel A. Orthopaedic long term aspects of bladder exstrophy. Clin Orthop Relat Res 1997;335:240–245. DOI: 10.1097/00003086-199702000-00024.

[46] Surer I, Baker LA, Jeffs RD, Gearhart JP. Modified Young–Dees–Leadbetter bladder neck reconstruction in patients with successful primary bladder closure elsewhere: A single institution experience. J Urol. 2001;165:2438–2440. DOI: 10.1016/S0022-5347(05)66224-6.

[47] Kasprenski M, Benz K, Maruf M, Jayman J, Di Carlo H, Gearhart J. Modern management of the failed bladder exstrophy closure: A 50-yr experience. Eur Urol Focus. 2020;6(2):383–389. DOI: 10.1016/j.euf.2018.09.008.

[48] Rudin YuE, Sokolov YuYu, Rudin AYu, Kirsanov AS, Medvedeva NV, Kartseva EV. Volume of surgery in the primary closure of bladder in children with bladder exstrophy. Russian journal of pediatric surgery. 2020;(1):21–28. (In Russ.) DOI: 10.18821/1560-9510-2020-24-1-21-28.

[49] Рудин Ю.Э., Соколов Ю.Ю., Рудин А.Ю., Кирсанов А.С., Медведева Н.В., Карцева Е.В. Объём операции при первичном закрытии мочевого пузыря у детей с экстрофией мочевого пузыря. Детская хирургия. 2020;(1):21–28. DOI: 10.18821/1560-9510-2020-24-1-21-28.

[50] Haffar A, Manyevitch R, Morrill C, Wu WJ, Maruf MN, Crigger C, Carlo HND, Gearhart JP. A single center's changing trends in the management and outcomes of primary closure of classic bladder exstrophy: An evolving landscape. Urology. 2023;175:181–186. DOI: 10.1016/j.urology.2022.12.064.

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