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11–14 APRIL, 2018, HELSINKI, FINLAND
14:30–14:33
S17-3 (PP)
PUBIC SYMPHYSIS APPROXIMATION DURING
BLADDER EXSTROPHY CLOSURE WITH ABSORBABLE
VS NON ABSORBABLE SUTURE
Sarah BRAUNGART, David KEENE, Anju GOYAL, Tamas CSERNI and Raimondo
CERVELLIONE
Royal Manchester Children's Hospital, Paediatric Urology, Manchester, UNITED KINGDOM
PURPOSE
Traditionally, non-absorbable suture has been used to approximate the pubic symphysis during
bladder exstrophy closure (BEC); erosion of suture through the urethra/bladder neck being a well-
known complication. The authors compared success and complications of BEC using absorbable
vs non-absorbable suture for pubic symphysis approximation.
MATERIAL AND METHODS
Data was prospectively collected on consecutive exstrophy patients treated in one single institu-
tion between 2013 and 2017. Data measured included: age at surgery, pubic diastasis, use of
osteotomy, type of pelvic immobilisation, success of closure, postoperative complications including
need for intrapubic suture removal at follow-up cystoscopy. Two groups were identified: A) use of
non-absorbable suture for pubic symphysis approximation, B) use of absorbable suture. Outcomes
were compared with Fisher's test (categorical data), t-test (continuous data), a p-value of <0.05 was
considered significant.
RESULTS
Fourty patients underwent BEC, 24 (4 female) in group A and 16 (9 female) in group B. Median age
at BEC was 6.8 months (IQR5.5–7.2) in group A and 7.6 months (IQR5.5–8.8) in group B (p=0.2).
Median pubic diastasis was 4.6 cm (4.4–5.1) in group A and 4.5 cm (4.0–5.4) in group B (p=0.8).
All patients received pelvic osteotomies with external pelvic fixation. All patients had a successful
BEC. In group A, 38 % of patients were found to have the intrapubic stitch migrated into urethra/
bladder neck at follow-up cystoscopy. 3 of these patients required excision of granuloma or stones
that had formed around the suture. No intrapubic stitch was found at follow-up cystoscopy in group
B (p=0.006).
CONCLUSIONS
Use of absorbable intrapubic sutures at time of BEC in the authors' hands does not affect success
of closure but prevents the morbidity associated with stitch erosion.
14:33–14:42
Discussion