The Y-Pelvic Osteotomy in Treating Bladder Exstrophy: A Surgical Technique

Abstract

Bladder exstrophy (BE) is a rare congenital anomaly caused by an embryological defect in the closure of the abdominal wall. It comprises a spectrum of defects about severity, including epispadias in the mildest form and cloacal exstrophy in the worst.Surgical correction is required to achieve urinary continence, maintain normal renal function, achieve secured abdominal wall closure, and create cosmetically and functionally satisfactory genitalia. Iliac bone osteotomy is considered essential to achieve the above goals in most patients by reducing the tension of the closed abdominal wall layers, particularly when present late in infancy.Several types of pelvic iliac bone osteotomy have been described to aid bladder and cloacal exstrophy closure. They can be grouped into posterior iliac osteotomy, anterior iliac osteotomy, oblique (also called diagonal) iliac osteotomy, and a combination of posterior and anterior iliac osteotomy.We described here the Y-pelvic osteotomy, which was developed by the Manchester Orthopaedic Group in the United Kingdom. It has the advantage of anterior and posterior osteotomies but also has less risk to the neurovascular structures, less blood loss, and ease of surgical technique. The osteotomy was named the Ypelvic osteotomy due to the morphological shape it resembles.

A long-term outcome (up to 29 years) of bilateral iliac wings “bayonet osteotomies” for closure of bladder exstrophy

“…The bilateral bayonet pelvic osteotomy proposed in this study was designed to close the symphyseal gap and improve both the pelvic external rotation and the pelvic shortening without needing additional posterior pelvic osteotomy, which was a time-consuming procedure and more blood loss. Moreover, other previous osteotomy techniques needed fixation, such as a k-wire or external fixator, to stabilize osteotomy sites [ 2 , 25 ]. However, in our technique with the bayonet cut, the osteotomy sites locked after folding both iliac wings and produced enough stable bone contact without any k-wire fixation needed.…”

The true pelvic volume change with various corrective osteotomy techniques for exstrophy-epispadias complex spectrum: the value of computer-assisted virtual surgery

“…Finally, as the osteotomy starts in the iliac crest, more space is available for stable fixation using two half pins in each hemipelvis (Fig. 4) [20].…”