Staged vs Non-Staged Pelvic Osteotomies in Cloacal Exstrophy: Ultrasound Insights in Modern Treatment

This study compares the effectiveness of staged and non-staged pelvic osteotomies in the closure of the wide pubic diastasis associated with cloacal exstrophy, focusing on orthopedic complications and closure outcomes. A retrospective review of 1510 patients with the exstrophy-epispadias complex was conducted, analyzing bladder closure procedures involving osteotomy. The review identified 64 closure events across 61 patients, of which 42 used staged osteotomy and 22 non-staged osteotomy. The mean diastasis among patients was 6.79 cm, and the median age at closure was approximately 609 days. Orthopedic complications were observed in 12 instances, with 6 classified as grade III/IV. Although staged osteotomy closures had more orthopedic complications (10 out of 42) compared to non-staged closures (2 out of 22), this difference was not statistically significant. Ultrasound imaging may have played a role in assessing the pelvic alignment and guiding surgical planning, especially for patients with more complex cases, though this study did not focus on its direct use. Importantly, staged osteotomy was associated with a higher rate of successful closure, particularly in primary closure cases (p=0.0241), with 57 successful closures out of 64 total events. No significant link was found between staged osteotomy and overall complication rates. The findings suggest that staged osteotomy can significantly improve outcomes by reducing the risk of closure failure and providing a safer alternative to non-staged procedures. Given these results, staged osteotomy should be considered the preferred method in cloacal exstrophy bladder closure.