Bilateral Anterior Osteotomy for Bladder Exstrophy at Older Age: A Case Report

Abstract

Introduction: Pubic diastasis in bladder exstrophy is a complex condition requiring intervention as soon as possible to achieve a tension-free abdominal wall. While most literature highlights the successful procedures conducted early, more studies need to report the management in older age. We herein report the management of pubic diastasis for bladder exstrophy at older age.

Case Presentation: A 12-year-old girl presented with bladder exstrophy requiring surgical reconstructive surgery with a team comprising of Orthopaedic, Urology and Plastic Surgery Departement. Intraoperatively, bilateral anterior osteotomy was performed to correct the 10 cm pubic diastasis. The correction then facilitated bladder reconstruction and subsequent skin closure overlying it. A modular external fixator was installed to maintain the correction. Then, a post-operative radiograph was obtained, and 1.5 cm of pubic diastasis was revealed.

Clinical Discussion: Bladder exstrophy is a congenital anomaly where the bladder is everted outside the body, affecting 2.07 of 100,000 births, with male predominance. Risk factors include alcohol, misoprostol, heparin, valproic acid, and diazepam exposure during pregnancy. The condition has a high potential for malignancy, with squamous cell carcinoma (SCC) as high as 3-40% due to intestinal epithelial metaplasia. Surgical procedures like pelvic osteotomy are advised due to advances in prenatal diagnosis.

Conclusions: Bilateral anterior osteotomy combined with an external fixation device could be a solution to correct pubic diastasis in bladder exstrophy among older age patients.