Staged closure of the pelvis in cloacal exstrophy: first description of a new approach.
OBJECTIVE
We describe a staged approach for pelvic closure in patients with cloacal exstrophy, and evaluate the technique for functional and cosmetic results.


METHODS
Staged closure of the pelvis was performed in 5 patients 12 months to 14 years old with cloacal exstrophy at our institution, including some referred with a history of failed closure. The technique involves initial pelvic osteotomy followed by soft tissue and pelvic ring closure 2 to 3 weeks later. Clinical information is reviewed to assess the effectiveness of the technique.


RESULTS
At a mean followup of 3.2 years (range 1 to 9) closure was successful in all 5 patients without technical problems or surgical complications, and with excellent functional and cosmetic results.


CONCLUSIONS
This technique of staged pelvic closure may provide reliable initial or secondary repair in patients with cloacal exstrophy in whom 1-stage pelvic closure is unfeasible even with pelvic osteotomy.
Division of Pediatric Urology, Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA.
R I
RI
Silver
P D
PD
Sponseller
J P
JP
Gearhart
D000293:Adolescent; D001746:Bladder Exstrophy / Q000601:surgery*; D002988:Cloaca / Q000002:abnormalities* / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D013520:Urologic Surgical Procedures / Q000379:methods*