title: Safety and efficacy of spica casts for immobilization following initial bladder closure in classic bladder exstrophy.
abstract: OBJECTIVE
  Pelvic immobilization constitutes a necessary component of successful bladder exstrophy closure. The efficacy of spica cast immobilization has been reported as markedly inferior to external fixation, with success rates below 25%. We reviewed our experience with spica cast immobilization following bladder closure.
  
  
  METHODS
  We retrospectively reviewed classic bladder exstrophy patients undergoing bladder closure with spica cast immobilization. Success of bladder closure and complications related to immobilization were noted, as were age, type of closure, use of osteotomy, duration of immobilization, and number of cast changes.
  
  
  RESULTS
  Fifteen patients underwent bladder closure (10 staged, 5 complete repair) at a median age of 4 days (range 1-6) and 14 were immobilized with spica casts. Initial closures were successful in 11 (73%). Success rates were higher in patients undergoing osteotomies (6/7, 86%) compared to those without osteotomies (5/8, 63%). No patients immobilized with spica casts developed serious complications related to their immobilization. Minor skin breakdown occurred in 3/14 patients (21%). Median time of immobilization was 39 days (range 22-48).
  
  
  CONCLUSIONS
  Spica casts are a safe, effective method of postoperative immobilization and are associated with a low risk of cast-related complications.
authors.affiliation: Department of Urology, University of Iowa, Iowa City, IA, USA.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Arlen
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Cooper
authors.forename: Jose
authors.initials: J
authors.lastname: Morcuende
authors.forename: J Christopher
authors.initials: JC
authors.lastname: Austin
mesh_terms: D001746:Bladder Exstrophy / Q000601:surgery*; D002370:Casts, Surgical / Q000009:adverse effects; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000151:congenital; D007231:Infant, Newborn; D008297:Male; D021782:Multicystic Dysplastic Kidney; D010027:Osteotomy; D011183:Postoperative Complications / Q000517:prevention & control*; D012149:Restraint, Physical / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014517:Ureteral Obstruction