title: Complications of bladder closure in cloacal exstrophy: Do osteotomy and reoperative closure factor in?
abstract: OBJECTIVE
  The aims of surgical management in cloacal exstrophy (CE) have shifted to optimizing outcomes and quality of life while minimizing morbidity. This report reviews the single-institution experience of complications of bladder closure in CE.
  
  
  METHODS
  Patients with CE were identified from a prospectively-maintained bladder exstrophy-epispadias complex database. Operative and follow-up data were analyzed to compare complications and failure rates of bladder closure between closures performed with and without osteotomy and primary versus reoperative closures.
  
  
  RESULTS
  Of 134 patients followed with CE, 112 met inclusion criteria. Median follow-up time was 3.05years. The failure rate among 112 primary closures (mean age 8.4months) was 31.3% versus 51.9% in reoperative closures (mean age 19.7months) (p=0.044). Complication rate among primary and reoperative closures was 17.9% and 33.3%, respectively (p=0.076). For closures with pelvic osteotomy, failure rate was 24.0% versus 45.9% without osteotomy (p=0.018). Among primary closures with osteotomy, the complication rate was 21.3% versus 10.8% without osteotomy (p=0.171).
  
  
  CONCLUSIONS
  Complications of bladder closure are common in CE. Pelvic osteotomy reduces failure rates without a significant rise in complications, which are often minor. There was no statistically significant difference in complication rates between reoperative and primary closures. However, reoperative closures were more likely to fail, emphasizing the importance of a successful primary closure.
  
  
  METHODS
  II: retrospective study.
authors.affiliation: Jeffs Division of Pediatric Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, United States.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Friedlander
authors.affiliation: Jeffs Division of Pediatric Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, United States.
authors.forename: Heather N
authors.initials: HN
authors.lastname: Di Carlo
authors.affiliation: Division of Pediatric Orthopaedics, Department of Orthopaedics, The Johns Hopkins University School of Medicine, Baltimore, MD, United States.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Sponseller
authors.affiliation: Jeffs Division of Pediatric Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, United States. Electronic address: Jgearha2@jhmi.edu.
authors.forename: John P
authors.initials: JP
authors.lastname: Gearhart
mesh_terms: D001006:Anus, Imperforate; D001746:Bladder Exstrophy / Q000601:surgery*; D004842:Epispadias / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006554:Hernia, Umbilical; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000379:methods; D011788:Quality of Life; D012086:Reoperation; D012189:Retrospective Studies; D012600:Scoliosis; D024162:Second-Look Surgery; D016896:Treatment Outcome; D014564:Urogenital Abnormalities; D013520:Urologic Surgical Procedures; D000099061:OEIS Complex
keywords: Bladder exstrophy and epispadias complex; Cloacal exstrophy; OEIS complex; Osteotomy