title: Spica casting compared to Bryant's traction after complete primary repair of exstrophy: safe and effective in a longitudinal cohort study.
abstract: OBJECTIVE
  Bryant's traction is the most commonly used method for immobilization after bladder exstrophy repair. We hypothesized that spica casting is a safe and effective alternative to Bryant's traction after complete primary repair of exstrophy.
  
  
  METHODS
  Complete primary repair of exstrophy was performed for initial repair in 39 consecutive children by all surgeons at Seattle Children's Hospital since 1998. Three sequential cohorts were evaluated-Bryant's traction without osteotomy (13 patients), spica casting without osteotomy (14) and spica casting with osteotomy. These 3 sequential cohorts represent eras of care and an evolution of practice. Primary outcomes included major complications related to immobilization, dehiscence, urinary incontinence and length of stay. We defined complications of immobilization as nonunion of pelvic osteotomy, femoral nerve palsy, revision of spica cast requiring return to the operating room, infection at the osteotomy site and activity limiting pain at the osteotomy site. Fisher's exact test or t test was used to determine statistical significance.
  
  
  RESULTS
  There was no difference in urinary continence (p = 0.09). Use of Bryant's traction was associated with double the length of stay (p >0.001). There was no correlation of major complications to the type of immobilization used.
  
  
  CONCLUSIONS
  Spica casting compared to Bryant's traction is associated with shorter hospitalization following complete primary repair of exstrophy and does not have a significant difference in the rate of complications. In our longitudinal cohort study with long-term followup spica cast was safe and effective for patients with bladder exstrophy, and should be considered an acceptable method of immobilization.
authors.affiliation: Department of Urology, University of Washington and Division of Pediatric Urology, Seattle Children's Hospital, Seattle, Washington 98105, USA. margarett.shnorhavorian@seattlechildrens.org
authors.forename: Margarett
authors.initials: M
authors.lastname: Shnorhavorian
authors.forename: Kit
authors.initials: K
authors.lastname: Song
authors.forename: Ismael
authors.initials: I
authors.lastname: Zamilpa
authors.forename: Brett
authors.initials: B
authors.lastname: Wiater
authors.forename: Michael M
authors.initials: MM
authors.lastname: Mitchell
authors.forename: Richard W
authors.initials: RW
authors.lastname: Grady
mesh_terms: D001746:Bladder Exstrophy / Q000601:surgery*; D002370:Casts, Surgical / Q000009:adverse effects; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D011182:Postoperative Care; D012149:Restraint, Physical / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D014143:Traction / Q000295:instrumentation* / Q000379:methods*; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods