APPLICATIONS OF OSTEOTOMY IN THE CLOACAL EXSTROPHY PATIENT

During the last 18 years we treated 22 patients with cloacal exstrophy of whom 13 were referred for further treatment after initial treatmen t elsewhere. One patient underwent cystectomy with ileal conduit urina ry diversion soon after birth anti 9 of the remaining 21 underwent ini tial closure without osteotomy. Of these 9 patients significant compli cations developed in 8 (89%) after bladder closure, including dehiscen ce in 6 (1 underwent 2 unsuccessful closures), a vesicocutaneous fistu la and postoperative ventral hernia in 1, and bladder prolapse in 1. I n contrast, complications developed in only 2 of the 12 patients (17%) who underwent osteotomy at the time of initial closure, including bla dder dehiscence in 1 and significant prolapse in 1. Patients who under went osteotomy and those who did not were similar in terms of the size of omphalocele, presence of myelomeningocele and time of primary clos ure. We also found that osteotomy or failed closure has no effect on t he eventual continence of cloacal exstrophy patients. While osteotomy is not the only variable involved in successful cloacal exstrophy clos ure, our results indicate the need for osteotomy in these patients to increase the success rate at the time of initial bladder closure.