The AP diameter of the pelvis: a new criterion for continence in the exstrophy complex?

Objective. Reconstructive surgery of bladder exstrophy remains a challenge. By using CT of the pelvis, we suggest a new pre- and post-operative invest igative procedure to define the AP diameter (APD) as a predictive criterion for continence in this anomaly. Patients and methods. Three axial CT slices were selected in nine children with exstrophy who had undergone neonatal reconstructive surgery. The three levels selected were the first sacral plate, the mid acetabular plane and the superior pubic spine. We used combined slices to measure: APD=distance between the first sacral vertebra and the pubic symphysis. Pubic diastasis (PD) Three angles defined on the transverse plane of the first sacral vertebra-i liac wing angle, sacropubic angle and acetabular version. Result,. In exstrophy, the angles demonstrate opening of the iliac wings an d the pubic ramus, and acetabular retroversion compared to controls. Compar isons between controls, continent and incontinent patients reveal that in c ontinent patients, APD increases with growth and seems to be a predictive c riterion for continence, independent of diastasis of the pubic symphysis. Conclusions. We believe that CT of the pelvis with measurements of the APD should be performed in all neonates with bladder exstrophy before reconstru ctive surgery and for better understanding of the malformation. The APD see ms to be predictive and may be a major criterion for continence, independen t of PD.