title: Magnetic resonance imaging of pelvic musculoskeletal and genitourinary anatomy in patients before and after complete primary repair of bladder exstrophy.
abstract: OBJECTIVE
  We characterize pelvic soft tissue and bony anatomy of patients before and after complete primary repair of exstrophy (CPRE).
  
  
  METHODS
  We evaluated 15 measurements on pelvic magnetic resonance imaging (MRI) in patients who underwent CPRE without osteotomy at our institution from 1996 to 2004. MRI protocols included axial, sagittal and coronal fast spin echo proton density sequences. Measurements were compared before and after CPRE using a paired t test, and between patients after CPRE, and age and gender matched controls using linear regression adjusting for the matched case-control groups. Patients older than 3 years with continent intervals longer than 3 hours after CPRE were compared to age and gender matched controls using linear regression.
  
  
  RESULTS
  A total of 29 MRIs in 18 patients with exstrophy were available for analysis. Median patient age at postoperative MRI was 25 months (range 4 to 36). The configuration of the post-CPRE pelvis was significantly different from that of controls in all parameters measured including wider symphyseal diastasis (34.5 mm vs less than 1 mm) and more obtuse iliac wing (121 degrees vs 98 degrees), puborectalis (94 degrees vs 49 degrees) and ileococcygeus angles (111 degrees vs 98 degrees ). The anatomy of continent patients after CPRE was not significantly different from that of controls in most parameters measured.
  
  
  CONCLUSIONS
  Comparison of the pelvic anatomy in patients before and after CPRE suggests that after CPRE patients have parameters that more closely approximate, but are still significantly different, from those of control patients. Patients with greater than 3-hour continent intervals after CPRE have anatomic parameters most similar to those of age matched controls.
authors.affiliation: Department of Urology and Radiology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA.
authors.forename: Patricio C
authors.initials: PC
authors.lastname: Gargollo
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Borer
authors.forename: Alan B
authors.initials: AB
authors.lastname: Retik
authors.forename: Craig A
authors.initials: CA
authors.lastname: Peters
authors.forename: David A
authors.initials: DA
authors.lastname: Diamond
authors.forename: Anthony
authors.initials: A
authors.lastname: Atala
authors.forename: Carol E
authors.initials: CE
authors.lastname: Barnewolt
mesh_terms: D001746:Bladder Exstrophy / Q000473:pathology* / Q000601:surgery*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D017773:Pelvic Floor / Q000473:pathology*; D012189:Retrospective Studies; D014566:Urogenital System / Q000473:pathology*