ABSTRACT
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.
Subject(s)
Bladder Exstrophy/surgery , Ilium/surgery , Osteotomy , Child , Child, Preschool , Female , Follow-Up Studies , Gait , Humans , Infant , Male , Methods , Pelvic Bones/diagnostic imaging , Pelvic Bones/growth & development , Radiography , Urinary Tract/physiopathologyABSTRACT
Fifty children and adolescents who had severe fecal incontinence associated with either imperforate anus surgery in infancy or longstanding functional constipation were given biofeedback training for the purpose of achieving anal sphincter control. Feedback was in the form of oscilloscope tracings which the children learned to produce by contracting small air-filled balloons positioned at the internal and external anal sphincters. Forty-seven of these patients learned to have voluntary bowel movements, and 30 eliminated soiling accidents completely during follow-up periods ranging from six months to three years.
