title: Is pelvic osteotomy associated with lower risk of pelvic organ prolapse in postpubertal females with classic bladder exstrophy?
abstract: OBJECTIVE
  Bladder exstrophy is a major congenital anomaly involving defects in the genitourinary tract and pelvic musculoskeletal system. It appears intuitive that closure of the pelvic ring using osteotomy would be associated with a decreased risk of pelvic organ prolapse. We investigated whether osteotomy is associated with a decreased risk of pelvic organ prolapse in females with classic bladder exstrophy.
  
  
  METHODS
  We searched our institutional review board approved exstrophy database of 1,078 patients and identified 335 females. We excluded patients who were younger than 13 years, had cloacal exstrophy or epispadias and did not have postpubertal imaging for measurement of pubic diastasis available. Our final study population consisted of 67 females. Univariate analysis was performed using t test or rank sum test for continuous variables and chi-square test for categorical variables. Logistic regression was used for multivariate analysis.
  
  
  RESULTS
  Median patient age was 23 years (range 13 to 60). A total of 20 patients (29.9%) had pelvic organ prolapse at a median age of 20 years (range 11 to 43). Of the 67 patients 25 (37.3%) had undergone osteotomy at a median age of 6 months (range birth to 10 years). Seven patients had at least 1 pregnancy (range 1 to 3), and 24 patients had undergone vaginoplasty. On univariate analysis only diastasis was associated with pelvic organ prolapse, with smaller diastasis associated with a decreased risk of prolapse. On multivariate analysis including diastasis and osteotomy only diastasis was statistically significant.
  
  
  CONCLUSIONS
  Osteotomy does not decrease the risk of pelvic organ prolapse in patients with classic bladder exstrophy. Rather, degree of diastasis is significantly associated with pelvic organ prolapse.
authors.affiliation: James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Ifeanyi
authors.initials: I
authors.lastname: Anusionwu
authors.forename: Nima
authors.initials: N
authors.lastname: Baradaran
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Trock
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Stec
authors.forename: John P
authors.initials: JP
authors.lastname: Gearhart
authors.forename: E James
authors.initials: EJ
authors.lastname: Wright
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D001746:Bladder Exstrophy / Q000175:diagnosis / Q000601:surgery*; D016009:Chi-Square Distribution; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D010027:Osteotomy / Q000379:methods*; D010384:Pelvic Bones / Q000601:surgery*; D056887:Pelvic Organ Prolapse / Q000453:epidemiology / Q000517:prevention & control*; D011247:Pregnancy; D019651:Plastic Surgery Procedures / Q000379:methods*; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult