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11–14 APRIL, 2018, HELSINKI, FINLAND
14:47–14:50
S17-5 (PP)
ANATOMY OF THE BONY PELVIS IN PATIENTS
WITH CLASSICAL BLADDER EXSTROPHY: A SURVEY
OF THE MULTICENTER GERMAN CURE-NET
Kathi ADAMCZYK
1
, Nadine ZWINK
2
, Ekkehart JENETZKY
3
, Eberhard
SCHMIEDEKE
4
, Thomas M. BOEMERS
5
, Margit FISCH
6
, Karin HIRSCH
7
, Raimund
STEIN
8
, Heiko REUTTER
9
, Wolfgang H. RÖSCH
10
and Anne Karoline EBERT
1
1) University Hospital Ulm, Department of Urology and Pediatric Urology, Ulm, GERMANY - 2) German Cancer
and Research Center Heidelberg, Division of Clinical Epidemiology and Aging Research, Heidelberg, GERMANY
- 3) University Medical Center Mainz, Department of Child and Adolescent Psychiatry and Psychotherapy, Mainz,
GERMANY - 4) Klinikum Bremen-Mitte, Department of Pediatric Surgery and Pediatric Urology, Bremen, GERMANY
- 5) University Hospital Köln, Department of Pediatric Surgery and Pediatric Urology, Köln, GERMANY - 6) University
Hospital Hamburg-Eppendorf, Department of Pediatric Urology, Hamburg, GERMANY - 7) University Hospital Erlangen,
Department of Pediatric Urology, Erlangen, GERMANY - 8) University Hospital Mannheim, Department of Pediatric
Urology, Mannheim, GERMANY - 9) University Children's Hospital, Department of Neonatology, Bonn, GERMANY -
10) Klinik St. Hedwig, University Medical Center Regensburg, Department of Pediatric Urology, Regensburg, GERMANY
PURPOSE
Although pelvic closure is important for the initial operative management of classical bladder exstro-
phy (CBE), there is a lack of long-term outcome measures in regards of pelvic and hip morphology.
MATERIAL AND METHODS
In the German multicenter network for congenital uro-rectal malformations (CURE-Net) database
symphysis diastasis width was determined either radiologically or intraoperatively in 82 CBE
individuals. Pelvic radiographs, available in 67 CBE patients, were screened for pathological hip
findings such as hip dysplasia or coxarthrosis.
RESULTS
The median symphysis diastasis was 5 cm (IQR 4–6). Radiologically measured symphysis width
was available in 48 individuals (67 % male, median 12 years; 33 % female, median 11 years).
Hereby, females showed a significantly wider diastasis than males (median 6 cm vs. 4 cm; p =
0.02). Subgroup analysis revealed no statistically significant difference regarding previous sym-
physis approximation or the kind of initial reconstruction. Radiographs showed hip dysplasia in
12 individuals (18 %; 5 female, 7 male; median age 15 years), the majority of them (83 %) had
undergone symphysis approximation in childhood (symphysis diastasis median 4.5 cm (IQR 4–6)).
Two further male adults 50 years and older (3 %) presented with coxarthrosis; both had symphysis
rediastasis of 4 cm after previous approximation.
CONCLUSIONS
It is known fact that symphysis diastasis persists in the long-term, even after symphysis approxima-
tion. Females with CBE have a significantly wider symphysis diastasis suggesting a gender-specific
influence of their pelvic shape. Hip dysplasia and coxarthrosis may occur in a considerable amount
of CBE patients. Therefore, hip complaints should be adequately diagnosed and treated.