Bladder exstrophy

Causes of bladder exstrophy

Your cause of bladder exstrophy is unknown, although a genetic and environmental link is suspected. This malformation is believed to occurbetween the fourth and fifth week of gestation and that it is linked to an alteration in the muscular and connective tissue.

During fetal growth there is a structure calledsewer related to the later reproductive, urinary and digestive systems. Adefect in this structure it would be the anatomical origin of bladder exstrophy. Incomplete closure occurs in the midline between the abdominal wall and the bladder.

Grades of bladder exstrophy

At the time of birth it can manifest itself in different clinical forms, with different degrees of involvement:

Isolated epispadias

• Is the way milder and affects the development of urethra and genitalia. In half of the cases it is associated with
• In boys, the urethra usually empties into the upper part of the penis, through an opening called.
• In girls the clitoris may be divided and the urinary opening abnormally located.

Classic bladder exstrophy

It supposes a defect in the urethra and bladder. The bladder is exposed from the abdominal wall and the umbilicus displaced downward and is accompanied by epispadias.

• In children it can be accompanied by and / or inguinal hernia.
• Clitoral duplication is common in girls. The digestive system can also be affected, especially rectum and anus.

Cloacal exstrophy

Is the way More serious because rectum, bladder, urethra, and genitalia they do not separate completely as the fetus develops. In the most complex cases It can be associated with serious abnormalities of the colon, rectum (usually associated with short bowel syndrome), spinal column (spina bifida), and spinal cord. His prognosis is worse. It is associated with high mortality during lactation.

Diagnosis

It can be detected in a control during pregnancy, although it can go unnoticed if it is small. Ultrasound can also detect other associated abnormalities that are not seen externally. Other times the diagnosis is made during the examination at birth.

Complementary tests are usually carried out for the anatomical study.

Treatment

The treatment is surgical and is usually done in different phases according to the global clinical manifestation.

Complex cases

The first procedure to be approached is the closure of the bladder and abdomen. Second, the urethra and sexual organs are repaired. Next, when the child is old enough to participate in the process of potty training, surgeons perform a bladder neck reconstruction.

Mild cases

• It is usually addressed during the first 48 hours of life.
• However, when it affects different organs, a highly complex surgery is required and at different times.

Sequelae in case of no treatment

• Total urinary incontinence
• Increased risk of
• Sexual dysfunction

What to expect from surgery

Surgical treatment achievescorrect urinary incontinence in more than 70% of cases.   Teladoc Health Consultant Physician