Editorial comment : Closure of bladder exstrophy with a bilateral anterior pubic osteotomy: Revival of an old technique

The authors of this article should be congratulated for reporting their experience of pubic osteotomy in children with exstrophy, which seems relatively straightforward and ‘orthopaedist-free’, although not adopted by many surgical teams. I wondered why, and the answer might be in the roles of pelvic osteotomy in the child with exstrophy. There is no doubt that the bilateral anterior pubic osteotomy, like several other techniques, is suitable for achieving a tension-free closure and filling the lower abdominal midline depression. Contrary to the anterior oblique iliac osteotomy, the reported technique does not change the depth of the pelvis, which is classically flattened in patients with exstrophy. This is an important point for relocating the bladder and bladder neck inside the pelvis, and possibly to restore some bladder func- tion. Pubic osteotomy also fails to bring together the corpora cavernosa to reconstruct the epispadiac penis, except if it is combined with the Kelly soft-tissue mobilization. As far as I know, there is no report of a combination of these two procedures. It would be interesting to know if this type of osteotomy remains stable in the long term and avoids the progressive separation of the two hemi-pelves seen with other types of osteotomy.