Exstrophy of the bladder: long-term results of bilateral posterior iliac osteotomies and two-stage anatomic repair.

One hundred cases of exstrophy of the bladder treated with bilateral posterior iliac osteotomies to facilitate anterior closure of the pelvis and soft tissues were reviewed. Sixty-nine cases followed 5 to 18 years were evaluated in terms of: success of anterior closure (95%); degree of urinary continence (45% with near normal continence); incidence of chronic urinary tract infection, dilation of upper urinary tract and need for ileal diversion (30%); the effect of bony reconstruction on hip and pelvic development. Modifications of the technique of pelvic stabilization anteriorly and a previously unreported complication of asymmetrical pelvic closure are presented. Closure of the bony pelvis appears to increase the success of repair of both in terms of soft-tissue closure and attainment of urinary continence. Follow-up examinations of the patients throughtout the growing years with special attention to possible development of pelvic obliquity or scoliosis are important.