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19–22 APRIL, 2017, BARCELONA, SPAIN
10:45–10:50
S7-2 (LO)
INTRAOPERATIVE MRI-GUIDED NAVIGATION
OF THE PELVIC FLOOR DURING EXSTROPHY CLOSURE
Heather DI CARLO
1
, Aylin TEKES
2
and John GEARHART
1
1) Johns Hopkins, Urology, Baltimore, USA - 2) Johns Hopkins, Radiology, Baltimore, USA
PURPOSE
Radical dissection of the urogenital fibers and the thickened smooth and striated muscle fibers
connecting the posterior urethra and bladder plate to the diastatic pubic rami is crucial for adequate
placement of the posterior vesicourethral unit deep within the pelvis during CBE and CE closure,
as well as ensuring successful outcomes. Intraoperative MRI guided navigation of the pelvic floor
offers a novel technique for identification of these important anatomic landmarks during exstrophy
closure.
MATERIAL AND METHODS
IRB and FDA approval was obtained for use of Brainlab
®
(Munich, Germany) intraoperative
MRI-guided navigation of the pelvic floor anatomy during closure of CBE and CE at the authors’
institution. Pre-operative pelvic MRI was obtained one day prior to closure in patients necessitating
pelvic osteotomies. Intraoperative registration was performed after pre-operative planning with
a pediatric radiologist utilizing five anatomic landmarks immediately prior to initiation of surgery.
Accuracy of identification of pelvic anatomy was assessed by three pediatric urologic surgeons and
one pediatric radiologist.
RESULTS
35 patients with CBE and 2 patients with CE closed at the authors’ institution have successfully
utilized Brainlab
®
technology to navigate and guide the dissection of the pelvic floor intraoperatively.
All patients had 100% accuracy in correlation of gross anatomic landmarks with MRI identified
landmarks intraoperatively, and all have had successful closure without any complication.
CONCLUSIONS
Brainlab
®
intraoperative MRI-guided pelvic floor navigation and dissection is an effective way to
accurately identify pelvic anatomy during CBE and CE closure. Future assessment of real-time
changes in pelvic floor anatomy comparing pre-closure to post-closure MRI will allow quantification
of pelvic floor anatomy in these patients and may allow for intra-institutional telementoring in this
most important first step of exstrophy reconstruction.
10:50–10:53
S7-3 (PP)
★
BLADDER EXSTROPHY TEMPLATE SIZE IS CORRELATED
WITH PUBIC DIASTASIS
David KEENE, Cezar NICOARA, Vytis KAZLAUSKAS, Alessandra SCALAS
and Raimondo CERVELLIONE
Royal Manchester Children’s Hospital, Paediatric Urology, Manchester, UNITED KINGDOM
PURPOSE
To determine if there is a relationship between the size of the bladder template, pubic diastasis and
subsequent bladder capacity in patients with bladder exstrophy (BE).