title: Use of biodegradable plates and screws for approximation of symphysis pubis in bladder exstrophy: applications and outcomes.
abstract: OBJECTIVE
  To investigate the feasibility of biodegradable plate and screws for the tension-free internal fixation of the symphysis pubis in patients with bladder exstrophy, with a particular emphasis on pelvic bone changes as seen on 3-dimensional computed tomography.
  
  
  METHODS
  A total of 11 children with bladder exstrophy underwent surgical repair with biodegradable plate and screw fixation (mean age 4.13 years). Of the 11 patients, 6 had a history of failed bladder closures and pelvic osteotomies, 1 had failed bladder closure, and 4 had no such history. All 11 children underwent single-stage classic bladder closure. Subsequently, the symphysis pubis was fixed by placing a biodegradable miniplate and screws. The patients remained in leg bandages for 2 weeks. The follow-up period was 6-50 months (average 30.1). Three-dimensional pelvic bone computed tomography was performed initially and at 6 months postoperatively.
  
  
  RESULTS
  All 11 children had an uneventful postoperative period, except for a superficial infection at the site of the suprapubic tube in 1 patient. The mean hospital stay was 13.4 days. The plate remained in situ, and no further surgery was needed to remove it. Pelvic 3-dimensional computed tomography revealed a 35.48 ± 1.50 mm, 20.06 ± 1.97 mm, and 10.73° ± 0.84° decrease in pubic diastasis, intertriradiate distance, and iliac wing angle at 6 months postoperatively, respectively. Significant improvement was seen in the patients' urinary continence and gait compared with the preoperative values. At the final follow-up visit, 6 patients were socially dry.
  
  
  CONCLUSIONS
  Internal fixation of the pubic arch using biodegradable plates as a biocompatible alternative to current metal fixation system offers intriguing potential for early exstrophy management. This adds a layer of security to the pubic closure, in addition to the current surgical armamentarium for bladder exstrophy.
authors.affiliation: Department of Urology, Children’s Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran. kajbafzd@sina.tums.ac.ir
authors.forename: Abdol-Mohammad
authors.initials: AM
authors.lastname: Kajbafzadeh
authors.forename: Saman Shafaat
authors.initials: SS
authors.lastname: Talab
authors.forename: Azadeh
authors.initials: A
authors.lastname: Elmi
authors.forename: Mona Vahidi
authors.initials: MV
authors.lastname: Rad
authors.forename: Tina
authors.initials: T
authors.lastname: Mazaheri
authors.forename: Roozbeh
authors.initials: R
authors.lastname: Tanhaeivash
mesh_terms: D020341:Absorbable Implants; D001746:Bladder Exstrophy / Q000601:surgery*; D001860:Bone Plates; D001863:Bone Screws; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011631:Pubic Symphysis / Q000601:surgery*; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000379:methods