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Is Pelvic Osteotomy Associated with Lower Risk of Pelvic Organ Prolapse in Postpubertal Females with Classic Bladder Exstrophy?
MedLine Citation:
PMID:  23088967     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE: 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. MATERIALS AND 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:
Ifeanyi Anusionwu; Nima Baradaran; Bruce J Trock; Andrew A Stec; John P Gearhart; E James Wright
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-19
Journal Detail:
Title:  The Journal of urology     Volume:  -     ISSN:  1527-3792     ISO Abbreviation:  J. Urol.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376374     Medline TA:  J Urol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Affiliation:
James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland. Electronic address: imegwal1@jhmi.edu.
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