Introduction Previous assumptions suggested that the technique of approximation without osteotomy in primary exstrophy repair (PER) could only be applied in newborns and anticipated poorer outcomes. Recent studies indicated that this technique can be successfully executed not only in immediate PER but also yields favorable long-term results. Therefore, we evaluated and compared the orthopaedic and radiological long-term outcomes after pubic symphysis approximation without osteotomy in immediate and delayed PER.

Methods From March 2018 to December 2020, individuals with PER and approximation of the symphysis without osteotomy were recruited. Patients <12 years and with a history of orthopaedic surgery of the bony pelvis were excluded. Orthopaedic examinations and magnetic resonance imaging (MRI) of the bony pelvis including the hip joints were performed and pubic diastasis, the acetabulum angle (ACA), and the center-edge angle (CEA) were evaluated.

Results Twenty-nine patients were included, 11 of them had an immediate and 18 had a delayed PER. Between the two groups, no significant differences could be observed concerning hip pain (p = 0.419), mobility impairment (p = 0.543), sports impairment (p = 0.543), hip impingement (p = 1.000), leg length discrepancy (p = 0.505), and width of the pubic diastasis as measured by MRI (p = 0.401). There were also no significant differences with regard to CEA right (median 30 degrees, p = 0.976), CEA left (median 31.5 degrees, p = 0.420), ACA right (median 19 degrees, p = 0.382), and ACA left (median 17 degrees, p = 0.880).

Conclusion There were no significant differences in clinical orthopaedic or radiological long-term outcomes between bladder exstrophy patients after immediate and delayed bladder closure with symphysis approximation without osteotomy. Establishing core outcome sets is essential to get robust and comparable results, further advancing and substantiating our initial insights.

M.P. contributed to study conception, data analysis, urological examinations, evaluation of the results, manuscript writing, and the revision and submission of the manuscript. He critically evaluated the manuscript and approved the final manuscript as submitted.

R.H. contributed to data analysis, orthopaedic examinations, evaluation of the results, and manuscript writing. He critically evaluated the manuscript and approved the final manuscript as submitted.

R.B. contributed to data analysis, performed the MRI, evaluation of the results, and manuscript writing. He critically evaluated the manuscript and approved the final manuscript as submitted.

A.H. contributed to data analysis and statistical data analysis, evaluation of the results, manuscript writing, and revision of the manuscript. He critically evaluated the manuscript and approved the final manuscript as submitted.

M.J.S. designed the study, contributed to data analysis, and evaluation of the results. He critically evaluated the manuscript and approved the final manuscript as submitted.

C.G. contributed to data analysis and statistical data analysis, evaluation of the results, manuscript writing, and revision of the manuscript. He critically evaluated the manuscript and approved the final manuscript as submitted.

S.B. contributed to the statistical data analysis and manuscript writing. She critically evaluated the manuscript and approved the final manuscript as submitted.

M.K. designed the study, contributed to data analysis and orthopaedic examinations. He interpreted the study findings critically, evaluated the manuscript, and approved the final manuscript as submitted.

W.H.R. designed the study, contributed to data analysis and urological examinations. He interpreted the study findings, critically evaluated the manuscript, and approved the final manuscript as submitted.

Received: 10 April 2024

Accepted: 29 September 2024

Article published online:
22 October 2024

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