title: Complications of primary closure of classic bladder exstrophy.
abstract: OBJECTIVE
  We report the urological, orthopedic and neurological complications of primary closure of classic bladder exstrophy using modern staged repair of exstrophy.
  
  
  METHODS
  An approved database identified 137 males and 57 females with classic bladder exstrophy who underwent primary repair by 1 of 2 surgeons in 23 years. A total of 185 patients underwent primary closure using modern staged repair of exstrophy with or without osteotomies, whereas 9 underwent delayed primary closure with epispadias repair at age 12 months. Of the patients 63 received osteotomies. Mean age at closure was 60 days and mean followup was 9 years.
  
  
  RESULTS
  There were 14 major complications (11%) and 27 minor complications (14%). Major urological complications included bladder prolapse or dehiscence in 6 male patients (3%), which was successfully reclosed. Major orthopedic complications, including osteotomy nonunion in 2 cases, leg length inequality in 1 and persistent joint pain in 1, developed in 4 of the 63 patients (6%) who underwent osteotomy. Major neurological complications included femoral nerve palsy in 4 patients (2%). There were 21 minor urological complications (11%), including posterior bladder outlet obstruction in 4 cases, urethrocutaneous fistula in 2, suprapubic tube removal in 2, intrapubic stitch erosion in 4, febrile urinary tract infection in 6 and surgical site infection in 3. Six patients (3%) had minor orthopedic complications, including pelvic osteomyelitis in 1, pin site infection in 3 and a pressure sore from immobilization in 1.
  
  
  CONCLUSIONS
  Closure of bladder exstrophy is a safe surgery with an acceptable risk of complications. A critical review of outcomes provides insight to further refine the technique and manage complications when they develop.
authors: Division of Pediatric Urology, Brady Institute of Urology, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors: Anthony J
authors: AJ
authors: Schaeffer
authors: J Todd
authors: JT
authors: Purves
authors: Jeremy A
authors: JA
authors: King
authors: Paul D
authors: PD
authors: Sponseller
authors: Robert D
authors: RD
authors: Jeffs
authors: John P
authors: JP
authors: Gearhart
mesh_terms: D001746:Bladder Exstrophy / Q000453:epidemiology / Q000601:surgery*; D015897:Comorbidity; D004842:Epispadias / Q000453:epidemiology / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010027:Osteotomy; D010384:Pelvic Bones / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D013529:Surgical Wound Dehiscence / Q000453:epidemiology; D001748:Urinary Bladder Neck Obstruction / Q000453:epidemiology / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000009:adverse effects*