Purpose: To investigate the factors affecting primary bladder closure in Cloacal exstrophy (CE). A successful primary closure is important for optimizing reconstructive outcomes, and it is a critical first-step in the reconstruction of CE. The authors' hypothesize that a smaller diastasis, use of osteotomy, and external fixation will remain predictors of a successful closure.
Methods: A prospectively maintained database of 1311 Exstrophy-epispadias complex (EEC) patients was reviewed for CE patients closed between 1975 and 2015. Univariate and multivariable analyses were performed to identify significant factors associated with CE primary bladder closure.
Results: Of 142 CE patients identified, 99 patients met inclusion criteria. Median follow-up time was 8.82 [IQR 5.43-14.26] years. The following variables were associated with outcome of closure: location of closure (p=0.002), type of closure (p<0.001), use of osteotomy (p<0.001), timing of osteotomy (p=0.005), duration of immobilization (p=0.02), and surgeon type (p=0.04). However, only type of closure (p=0.023) and use of osteotomy (p=0.004) remained significant in the multivariable model. The odds of having a successful closure are about 4 times greater for the staged cloacal approach compared to the 1-stage approach (OR, 3.7; 95% CI 1.2-11.5; P-value=0.023), and having an osteotomy increases the chance of a successful closure by almost six-fold (OR, 5.8; 95% CI 1.7-19.6; P-value=0.004).
Conclusions: Using the staged approach and utilizing a pelvic osteotomy are paramount to a successful primary closure in CE. The authors strongly recommend using the staged approach and osteotomy as it greatly increases the chance for a successful primary bladder closure.