Bladder exstrophy - causes, symptoms, diagnosis and treatment

Exstrophy - Malformation of the genitourinary system, in which the formation of the bladder and the anterior abdominal wall in its projection remains incomplete. From birth, there is an open and turned inside out the mucous membrane of the rear wall of the bladder, as well as the permanent separation and drainage of urine from the opening in the bottom of the body of the ureter ducts. Exstrophy of the bladder is often associated with defects of the external and internal sex organs, ureters and kidneys. It is diagnosed by the characteristic external features, additionally performed radiological and ultrasound examination. Treatment operative, performed reconstructive plastic surgery and substitution.

  • Causes of bladder exstrophy
  • Symptoms of bladder exstrophy
  • Diagnosis and treatment of bladder exstrophy
  • Bladder exstrophy - treatment

  • Exstrophy


    pediatrics and surgery are faced with great difficulties in the treatment of bladder exstrophy, although the first surgery for the correction of this anomaly were proposed back in the 1960s. Reconstruction and plastic do not lead to a cure. The continued incontinence significantly affects the quality of life of the child, and frequent infections are rising cause of chronic kidney failure, a serious threat to life.

    smoking, intrauterine infections, some medications, and so on. d. Fetal Injury may also contribute to a violation of the right to the development of embryonic malformations.

    The main pathogenetic moment bladder exstrophy - delayed return of cloacal septum, which prevents the introduction of mesodermal sheet between the outer and inner layers embryonic. This leads to the fact that the process of forming the bladder walls is incomplete and body remains open and everted outwardly. These processes normally take place on 4-6 week of embryonic development, so the impact of teratogenic factors, the most dangerous in the beginning of pregnancy. However, this concerns not only the bladder exstrophy, but the majority of malformations.

    Pediatrician pay attention to bright red mucous membrane of the bladder, which replaces the missing portion of the anterior abdominal wall. Mucous usually has normal morphology, but possibly psevdopapillomatoznoe change. In the lower part apparent ureteral orifice from which urine is released continuously. Over time, the main problem with the bladder exstrophy becomes irritated urinary salts of the surrounding tissue, the constant maceration around the outdoor area and in the hips. Infection of the mucosa of the bladder is the cause ascending infection of the kidneys and ureters.

    Exstrophy of the bladder is often associated with the splitting of the ureters. In addition, exstrophy is always accompanied by the divergence of the pubic symphysis. This leads to the fact that attach thereto anorectal muscles that normally keep the external anal sphincter, begin to stretch it. Patients it is located laterally closer to the urethra and compared with the norm. Therefore, one of the symptoms of bladder exstrophy is fecal incontinence. Because of anatomical differences in boys and girls there are various changes in the adjacent organs. The boys found splitting the corpus cavernosum or reduction, in girls - the splitting of the clitoris, vagina anomaly development.

    abdominal radiography combined to identify defects in the first place, in the urinary system, but also in the intestines and the spinal cord (the most typical combination with exstrophy). With the same purpose carried ultrasound. Recommended excretory urography, which allows you to verify the integrity and correct development of the ureters and kidneys.

    Treatment operative. Type depends on the degree of bladder extrophy - namely, on the size and body everted portion, respectively, the missing segments of the anterior abdominal wall, as well as related malformations. If the defect size does not exceed 4 cm performed reconstructive surgical intervention, which aims - the closure of the defect with the help of the surrounding tissue and restoring the integrity of the bladder. That's enough, because the body histologically developed properly, despite the pathological anatomy.

    In the case of large size of defect creates an artificial bladder, which can perform the function of the reservoir and discharged at will. Also part of the ureter are displayed in the sigmoid colon, it is a mandatory measure in the event of their cleavage. Big problem for surgeons is the divergence of the pelvis with bladder exstrophy. This fact is the cause of the majority of fatal complications, such as urinary and fecal incontinence. The accumulated medical experience indicates a high frequency of unsatisfactory results of operations, due to the large number of associated defects and significant defect of the anterior abdominal wall.

    Prediction and prevention of bladder exstrophy



    The prognosis for recovery doubtful. Non-operated patients rarely live up to 10 years. With regard to the success of surgical treatment, the interventions carried out by 20-80% lead only to a slight improvement. Violations continue to progress urodynamics, incontinence persists. The risk of ascending infection remains high. Prevention of bladder exstrophy is possible in the antenatal period, even better - at a stage of planning of pregnancy to minimize the risk of teratogenic effects of factors, especially on stage bookmarks major organs and systems, that is, in the first 4-8 weeks of fetal development.