title: Impact of pelvic osteotomy on the incidence of inguinal hernias in classic bladder exstrophy.
abstract: OBJECTIVE
  The high prevalence of inguinal hernias in the bladder exstrophy population is well documented. The authors' aim is to determine whether pelvic osteotomy reduces the incidence of primary and recurrent inguinal hernias in patients with classic bladder exstrophy.
  
  
  METHODS
  Using an institutionally-approved database, patients who underwent immediate or delayed primary bladder closure between 1974 and 2012 were identified and stratified by the use of pelvic osteotomy at the time of closure. Data were analyzed using Fisher's exact test and multivariate logistic regression analysis.
  
  
  RESULTS
  One hundred thirty-six patients were identified with a median follow up of 8years. The incidence of inguinal hernias following closure was 25% in the osteotomy group versus 46% in the non-osteotomy group (p=0.017). Osteotomy was associated with a significant decrease in recurrence of inguinal hernias amongst patients who underwent previous repair (17% versus 47%, osteotomy versus non-osteotomy, p=0.027) and the development of primary inguinal hernias in whom initial groin exploration was negative (20% versus 39%, p=0.029). Osteotomy and female sex were associated with a decreased rate of inguinal hernia development after bladder closure while age at closure was not.
  
  
  CONCLUSIONS
  Pelvic osteotomy at the time of exstrophy closure decreases the likelihood of primary or recurrent inguinal hernia development.
authors.affiliation: University of Maryland School of Medicine, Division of Urology, 22S. Greene Street, Suite NGE19, Baltimore, MD 21201.
authors.forename: Garjae
authors.initials: G
authors.lastname: Lavien
authors.affiliation: The Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, 1800 Orleans St., Suite 7203, Baltimore, MD 21287. Electronic address: hdicarl1@jhmi.edu.
authors.forename: Heather N
authors.initials: HN
authors.lastname: Di Carlo
authors.affiliation: The Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, 1800 Orleans St., Suite 7203, Baltimore, MD 21287.
authors.forename: Bhavik B
authors.initials: BB
authors.lastname: Shah
authors.affiliation: The Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, 1800 Orleans St., Suite 7203, Baltimore, MD 21287.
authors.forename: John
authors.initials: J
authors.lastname: Eifler
authors.affiliation: The Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, 1800 Orleans St., Suite 7203, Baltimore, MD 21287.
authors.forename: Eric
authors.initials: E
authors.lastname: Massanyi
authors.affiliation: Medical University of South Carolina, Department of Urology, 96 Jonathan Lucas St, CSB 644, Charleston, SC 29425.
authors.forename: Andrew
authors.initials: A
authors.lastname: Stec
authors.affiliation: The Johns Hopkins University School of Medicine, Division of Pediatric Orthopedics, The Johns Hopkins Outpatient Center, 601N. Caroline St., Room 5152, Baltimore, MD 21287.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Sponseller
authors.affiliation: The Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, 1800 Orleans St., Suite 7203, Baltimore, MD 21287.
authors.forename: John P
authors.initials: JP
authors.lastname: Gearhart
mesh_terms: D001746:Bladder Exstrophy / Q000150:complications / Q000601:surgery*; D005260:Female; D006552:Hernia, Inguinal / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D010027:Osteotomy; D010384:Pelvic Bones / Q000601:surgery*; D012008:Recurrence; D001743:Urinary Bladder / Q000601:surgery*; D013520:Urologic Surgical Procedures
keywords: Bladder exstrophy; Inguinal hernia; Pelvic osteotomy