title: Repeat pelvic osteotomy in patients with failed closure of bladder exstrophy: applications and outcomes.
abstract: OBJECTIVE
  In patients with failed primary or secondary closure of bladder exstrophy, repeat osteotomy is useful in facilitating reconstruction. The clinical consequences of repeated surgical disruption of the pelvic ring have not been carefully described, however.
  
  
  METHODS
  We reviewed our experience with exstrophy patients who had undergone repeat pelvic osteotomy (RPO) and analyzed patient history, complications, and orthopedic outcomes.
  
  
  RESULTS
  Fifty-six patients who underwent RPO were identified. All had previously failed at least one attempted bladder closure. The patients underwent RPO at a mean age of 23.2 months. The mean time from initial osteotomy to RPO was 20.5 months. Anterior innominate or combined iliac/innominate approaches comprised 80% of RPO procedures. Of the patients, 95% had a normal gait after RPO; all 3 patients with an abnormal gait had osteotomy site nonunion, which was treated with bone grafting. Five patients had local fixator pin site infections, which were managed with local care and oral antibiotics, and 1 patient had late osteomyelitis requiring incision and drainage. No patient had femoral or sciatic nerve palsy after RPO at our institution.
  
  
  CONCLUSIONS
  Orthopedic complications after RPO are uncommon, and most patients have a normal gait postoperatively. Repeat pelvic osteotomy is useful in the complex reconstruction of failed exstrophy closures, and few cases fail reclosure when the reconstruction is combined with RPO.
authors.affiliation: Division of Pediatric Urology, Department of Urology, The James Buchanan Brady Urological Institute, Baltimore, MD, USA.
authors.forename: Caleb P
authors.initials: CP
authors.lastname: Nelson
authors.forename: Jeremy
authors.initials: J
authors.lastname: King
authors.forename: Paul D
authors.initials: PD
authors.lastname: Sponseller
authors.forename: John P
authors.initials: JP
authors.lastname: Gearhart
mesh_terms: D001746:Bladder Exstrophy / Q000601:surgery*; D001858:Bone Nails / Q000009:adverse effects; D016025:Bone Transplantation; D002648:Child; D002675:Child, Preschool; D005260:Female; D005684:Gait; D006801:Humans; D007223:Infant; D008297:Male; D010019:Osteomyelitis / Q000209:etiology; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods; D010384:Pelvic Bones / Q000601:surgery*; D011184:Postoperative Period; D011446:Prospective Studies; D012086:Reoperation; D013530:Surgical Wound Infection / Q000209:etiology; D017211:Treatment Failure; D016896:Treatment Outcome