Abstract：
To review the outcomes of classic bladder exstrophy (CBE) closure without the use of osteotomy or lower extremity/pelvic immobilization.
A prospectively maintained institutional approved exstrophy-epispadias complex database of 1487 patients was reviewed for patients with CBE who had undergone closure without osteotomy nor immobilization. All patients were referred to the authors\' institution for reconstruction later in life or for failed closure.
Of a total of 1016 CBE patients, 56 closure events were identified that met inclusion with a total of 47 unique patients. Thirty-eight closures were completed prior to 1990 (67.9%). Forty-five closure events developed eventual failure (45/56, 80.4%) (Table 1). Thirteen closure events were secondary closures (13/56, 23.2%). The primary closure failure rate was 83.7% (36/43) while the secondary closure failure rate was 69.2% (9/13). Failures were attributed to one or more of dehiscence, bladder prolapse, and vesicocutaneous fistula (25/45, 55.6%) (23/45, 51.1%) (6/45, 13.3%), respectively. Thirty-seven patients developed social continence (37/47, 78.7%), while only 8 patients developed spontaneous voided continence (7/47,17.0%) (Table 2). The most common methods of voiding were continent catheterizable channels (25/47, 53.2%) of which all were socially continent.
These results illustrate the critical role osteotomy and postoperative immobilization can play in both primary and secondary exstrophy closure. While this is a historical case series, the authors believe that these results remain relevant to contemporary exstrophy surgeons.
A prospectively maintained institutional approved exstrophy-epispadias complex database of 1487 patients was reviewed for patients with CBE who had undergone closure without osteotomy nor immobilization. All patients were referred to the authors\' institution for reconstruction later in life or for failed closure.
Of a total of 1016 CBE patients, 56 closure events were identified that met inclusion with a total of 47 unique patients. Thirty-eight closures were completed prior to 1990 (67.9%). Forty-five closure events developed eventual failure (45/56, 80.4%) (Table 1). Thirteen closure events were secondary closures (13/56, 23.2%). The primary closure failure rate was 83.7% (36/43) while the secondary closure failure rate was 69.2% (9/13). Failures were attributed to one or more of dehiscence, bladder prolapse, and vesicocutaneous fistula (25/45, 55.6%) (23/45, 51.1%) (6/45, 13.3%), respectively. Thirty-seven patients developed social continence (37/47, 78.7%), while only 8 patients developed spontaneous voided continence (7/47,17.0%) (Table 2). The most common methods of voiding were continent catheterizable channels (25/47, 53.2%) of which all were socially continent.
These results illustrate the critical role osteotomy and postoperative immobilization can play in both primary and secondary exstrophy closure. While this is a historical case series, the authors believe that these results remain relevant to contemporary exstrophy surgeons.
摘要：
目的：回顾不使用截骨或下肢/骨盆固定的经典膀胱外翻封闭的结果。
方法：回顾了一个前瞻性维护的机构批准的外翻-外翻复杂数据库，该数据库包含1487例患者，这些患者在没有截骨或固定的情况下进行了闭合的CBE患者。所有患者均被转诊至作者机构，以便在以后的生活中进行重建或关闭失败。
结果：在总共1016例CBE患者中，确定了56例闭合事件，共纳入47例独特患者。在1990年之前完成了38个关闭（67.9％）。45个闭合事件最终失败（45/56，80.4%）（表1）。13例闭合事件为二次闭合（13/56，23.2%）。一次闭合失败率为83.7%(36/43)，二次闭合失败率为69.2%(9/13)。失败归因于一种或多种：开裂，膀胱脱垂,膀胱皮肤瘘(25/45,55.6%)(23/45,51.1%)(6/45,13.3%)。37例患者出现社交节制（37/47，78.7%），而只有8例患者出现自发性尿失禁(7/47,17.0%)(表2)。最常见的排尿方法是大陆的可导管通道（25/47，53.2％），其中全部是社会大陆。
结论：这些结果说明了截骨和术后固定在原发性和继发性外翻闭合中的关键作用。虽然这是一个历史案例系列，作者认为，这些结果仍然与当代exstrophy外科医生相关。
方法：回顾了一个前瞻性维护的机构批准的外翻-外翻复杂数据库，该数据库包含1487例患者，这些患者在没有截骨或固定的情况下进行了闭合的CBE患者。所有患者均被转诊至作者机构，以便在以后的生活中进行重建或关闭失败。
结果：在总共1016例CBE患者中，确定了56例闭合事件，共纳入47例独特患者。在1990年之前完成了38个关闭（67.9％）。45个闭合事件最终失败（45/56，80.4%）（表1）。13例闭合事件为二次闭合（13/56，23.2%）。一次闭合失败率为83.7%(36/43)，二次闭合失败率为69.2%(9/13)。失败归因于一种或多种：开裂，膀胱脱垂,膀胱皮肤瘘(25/45,55.6%)(23/45,51.1%)(6/45,13.3%)。37例患者出现社交节制（37/47，78.7%），而只有8例患者出现自发性尿失禁(7/47,17.0%)(表2)。最常见的排尿方法是大陆的可导管通道（25/47，53.2％），其中全部是社会大陆。
结论：这些结果说明了截骨和术后固定在原发性和继发性外翻闭合中的关键作用。虽然这是一个历史案例系列，作者认为，这些结果仍然与当代exstrophy外科医生相关。
