Four-neonate study links early osteotomy to favorable renal and orthopedic trends

In a small retrospective case series of four neonates treated for cloacal exstrophy, early pelvic osteotomy during the first week of life was associated with trends toward better preservation of renal function, earlier regression of vesicoureteral reflux and more favorable orthopedic findings. The study was conducted at a tertiary referral center between 2013 and 2024, with a minimum follow-up of 24 months, and its authors cautioned that the very small sample does not establish causation or identify an optimal surgical strategy.

Cloacal exstrophy is the most severe form of the bladder exstrophy–epispadias complex and one of the rarest congenital anomalies encountered in pediatric surgery. The investigators used a prospectively maintained database of patients with the bladder exstrophy–epispadias complex to review the clinical characteristics, surgical management and early- to mid-term outcomes of the four consecutive neonates. They assessed renal function, vesicoureteral reflux, continence-related indicators, orthopedic outcomes, growth, postoperative complications and quality of life.

Clinical management began with neonatal stabilization and proceeded to staged abdominal reconstruction, with simultaneous or delayed pelvic osteotomy selected according to each child’s anatomical and clinical characteristics. Two patients underwent primary bladder closure with simultaneous pelvic osteotomy during the first week of life, while two received delayed staged reconstruction. The patients managed with early pelvic osteotomy showed trends toward better preservation of renal function, earlier reflux regression and more favorable orthopedic findings. Because the series included only four children and treatment was not assigned experimentally, these observations remain associations rather than evidence that early osteotomy caused the outcomes.

Continence-related results were mixed across the group. Three patients achieved daytime dry intervals, while one experienced limited nighttime dryness. One patient developed short bowel syndrome requiring prolonged parenteral nutrition and also experienced recurrent catheter-related sepsis and growth impairment. Follow-up measurements showed that children with a more stable clinical course had higher scores on the Pediatric Quality of Life Inventory, an instrument used to assess quality of life. The report did not establish that surgical treatment or continence outcomes alone produced those score differences.

The case series concludes that cloacal exstrophy management must extend beyond anatomical reconstruction to coordinate urinary function, orthopedic outcomes, nutrition, infection prevention, growth and quality-of-life assessment. It also identifies the need for larger multicenter studies using standardized long-term follow-up to evaluate the apparent advantages associated with early pelvic osteotomy. Until such evidence is available, the trends reported in these four patients should be interpreted cautiously rather than treated as proof of superior or definitive surgical management.

Subject of Research: A four-neonate retrospective case series of surgical management and early- to mid-term outcomes in cloacal exstrophy.

Article Title: Surgical management and early outcomes of cloacal exstrophy: a single-center experience

Article References: Ural, D. A., Cömert, H. S. Y., & Saruhan, H. (2026). Surgical management and early outcomes of cloacal exstrophy: a single-center experience. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07517-8

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07517-8

Keywords: cloacal exstrophy, pelvic osteotomy, bladder reconstruction, pediatric surgery, renal function, vesicoureteral reflux, continence outcomes, short bowel syndrome, case series, multidisciplinary care, Surgical, management