Use of biodegradable plates and screws for approximation of symphysis pubis in bladder exstrophy: applications and outcomes.

Autor: Kajbafzadeh AM; Department of Urology, Children’s Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran. kajbafzd@sina.tums.ac.ir, Talab SS, Elmi A, Rad MV, Mazaheri T, Tanhaeivash R
Jazyk: angličtina
Zdroj: Urology [Urology] 2011 May; Vol. 77 (5), pp. 1248-53. Date of Electronic Publication: 2011 Jan 06.
DOI: 10.1016/j.urology.2010.05.062
Abstrakt: Objectives: To investigate the feasibility of biodegradable plate and screws for the tension-free internal fixation of the symphysis pubis in patients with bladder exstrophy, with a particular emphasis on pelvic bone changes as seen on 3-dimensional computed tomography.
Methods: A total of 11 children with bladder exstrophy underwent surgical repair with biodegradable plate and screw fixation (mean age 4.13 years). Of the 11 patients, 6 had a history of failed bladder closures and pelvic osteotomies, 1 had failed bladder closure, and 4 had no such history. All 11 children underwent single-stage classic bladder closure. Subsequently, the symphysis pubis was fixed by placing a biodegradable miniplate and screws. The patients remained in leg bandages for 2 weeks. The follow-up period was 6-50 months (average 30.1). Three-dimensional pelvic bone computed tomography was performed initially and at 6 months postoperatively.
Results: All 11 children had an uneventful postoperative period, except for a superficial infection at the site of the suprapubic tube in 1 patient. The mean hospital stay was 13.4 days. The plate remained in situ, and no further surgery was needed to remove it. Pelvic 3-dimensional computed tomography revealed a 35.48 ± 1.50 mm, 20.06 ± 1.97 mm, and 10.73° ± 0.84° decrease in pubic diastasis, intertriradiate distance, and iliac wing angle at 6 months postoperatively, respectively. Significant improvement was seen in the patients' urinary continence and gait compared with the preoperative values. At the final follow-up visit, 6 patients were socially dry.
Conclusions: Internal fixation of the pubic arch using biodegradable plates as a biocompatible alternative to current metal fixation system offers intriguing potential for early exstrophy management. This adds a layer of security to the pubic closure, in addition to the current surgical armamentarium for bladder exstrophy.
(Copyright © 2011. Published by Elsevier Inc.)
Databáze: MEDLINE
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