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Haddad E, Hayes LC, Price D, Vallery CG, Somers M, Borer JG. Ensuring our exstrophy-epispadias complex patients and families thrive. Pediatr Nephrol 2024; 39:371-382. [PMID: 37410166 DOI: 10.1007/s00467-023-06049-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/17/2023] [Accepted: 06/01/2023] [Indexed: 07/07/2023]
Abstract
Individuals with bladder exstrophy-epispadias complex (EEC) need long-term integrated medical/surgical and psychosocial care. These individuals are at risk for medical and surgical complications and experience social and psychological obstacles related to their genitourinary anomaly. This care needs to be accessible, comprehensive, and coordinated. Multiple surgical interventions, reoccurring hospitalizations, urinary and fecal incontinence, extensive treatment regimens for continent diversions, genital differences, and sexual health implications affect the quality of life for the EEC patient. Interventions must include psychosocial support, medical literacy initiatives, behavioral health services, school and educational consultation, peer-to-peer opportunities, referrals to disease-specific camps, mitigation of adverse childhood events (ACEs), formal transition of care to adult providers, family and teen advisory opportunities, and clinical care coordination. The priority of long-term kidney health will necessitate strong collaboration among urology and nephrology teams. Given the rarity of these conditions, multi-center and global efforts are paramount in the trajectory of improving care for the EEC population. To achieve the highest standards of care and ensure that individuals with EEC can thrive in their environment, multidisciplinary and integrated medical/surgical and psychosocial services are imperative.
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Affiliation(s)
- Emily Haddad
- Cook Children's Health Care System, Fort Worth, TX, USA.
| | - Lillian C Hayes
- Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Diane Price
- Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christina G Vallery
- Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Somers
- Department of Nephrology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph G Borer
- Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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2
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Mecarini F, Fanos V, Crisponi G. Genital anomalies in newborns. J Perinatol 2021; 41:2124-2133. [PMID: 33649448 DOI: 10.1038/s41372-021-00991-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 01/15/2021] [Accepted: 02/03/2021] [Indexed: 02/05/2023]
Abstract
Examination of genitalia should be an essential part of newborn assessment. Early detection of congenital disorders is essential to begin appropriate medical or surgical therapy and to prevent complications that could profoundly affect a child's life. The present review aims to describe the main genital anomalies in infants and provide images in order to help the physician in current clinical practice.
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Affiliation(s)
- Federico Mecarini
- Neonatal Intensive Care Unit, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy.
| | - Vassilios Fanos
- Neonatal Intensive Care Unit, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - Giangiorgio Crisponi
- Neonatal Intensive Care Unit, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
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3
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New Insights on the Basic Science of Bladder Exstrophy-epispadias Complex. Urology 2020; 147:256-263. [PMID: 33049233 DOI: 10.1016/j.urology.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 11/20/2022]
Abstract
The exstrophy-epispadias complex is a rare congenital anomaly presenting as a wide spectrum of disorders. The complex nature of this malformation leads to continuous investigations of the basic science concepts behind it. Elucidating these concepts allows one to fully understand the mechanisms behind the disease in order to improve diagnosis, management, and treatment ultimately leading to improvement in patient quality of life. Multiple technological advancements within the last 10 years have been made allowing for new studies to be conducted. Herein, the authors conduct a literature review of studies from 2009 to 2019, considering novel theories regarding the genetics, embryology, bladder, bony pelvis, prostate, and genitalia of patients with bladder exstrophy-epispadias complex.
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Łosińska J, Respondek-Liberska M. Extraordinary Bulging Mass in the Foetus - A Case Report of Bladder Exstrophy. PRENATAL CARDIOLOGY 2018. [DOI: 10.1515/pcard-2018-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
INTRODUCTION: Prenatal diagnosis of bladder exstrophy is extremley rare and difficult. BACKGROUND: Due to abnormal development of the cloacal membrane there is an incomplete closure of the lower abdominal wall, absence of the anterior wall of the bladder and external exposition of the posterior wall. The pubic bones are usually separated, the umbilical cord low inserted and there is abnormal external genitalia development. CASE REPORT: At 21st week of gestation of 39-year-old multigravida multipara referred by a primary care obstetrician to high-specialised centre for a detailed ultrasound examination with a suspicion of bladder absence and inferior umbilical localisation. At 29 weeks of gestation presence of bulging mass of 2 cm, between the umbilical outlet and labia was detected. At 31 weeks of gestation previously detected structure among thighs had 3 cm diameter with lateral umbilical outlet. Major labia were prominent and minor labia were within normal limits. Between two umbilical arteries with an appropriate intraabdominal course there were no transsonic area corresponding to the urinary bladder. The newborn baby was born at term in a good condition, but with an exposed bladder of 4 cm in diameter. The urethral outlet was not visualised and the female genitals were abnormal. After a month the girl underwent primary bladder exstrophy closure. Although she suffers from recurring urinary tract infections, she is in a good general condition. CONCLUSIONS: Due to prenatal diagnostics it was possible to detect and make an initial diagnosis of severe malformation. Early diagnosis allowed to prepare parents for a newborn with a defect and teach them how to take care of the baby.
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Affiliation(s)
| | - Maria Respondek-Liberska
- Department of Prenatal Cardiology Polish Mother's Memorial Hospital Research Institute. Lodz , Poland
- Department of Diagnosis and Prevention of Fetal Malformations, Medical University, Lodz , Poland
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Antomarchi J, Moeglin D, Laurichesse H, Combourieu D, Bigi N, Maisonneuve E, Legac P, Althuser M, Delotte J, Jouannic JM, Bongain A. The Pubic Diastasis Measurement, a Key Element for the Diagnosis, Management, and Prognosis of the Bladder Exstrophy. Fetal Diagn Ther 2018; 45:435-440. [PMID: 30231253 DOI: 10.1159/000492817] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 08/10/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To demonstrate the feasibility of measuring the fetal pubic diastasis (PD) distance on antenatal ultrasound in normal fetuses and to compare it to fetuses with bladder exstrophy. METHODS Firstly, a prospective multicentric study was conducted to determine the feasibility of the PD ultrasound measurement during the second half of pregnancy. Secondly, data from a single center were used to develop a nomogram for PD values in normal fetuses. Thirdly, retrospective PD measurements were collected from fetuses with bladder exstrophy, diagnosed in seven French Multidisciplinary Centers for Prenatal Diagnosis (MCPDs). RESULTS Operators from several MCPDs examined 868 fetuses and found that overall PD ultrasound measurement was feasible in 71% of cases and that the ossification of pubic points increased to be always visible from 27 weeks of gestation onward. Performed in a single center by a referring operator on 1,539 fetuses, the feasibility reached 94.74%. Both set of measurements were concordant (mean PD distance value of 5.42 ± 1.8 mm). Interestingly, all 23 fetuses with bladder exstrophy showed a significantly larger PD distance (mean 15.74 ± 3.9 mm). CONCLUSION PD measurement in the fetus is feasible and reliable in the second half of gestation and can be used to support the antenatal diagnosis of bladder exstrophy with PD values exceeding 10 mm.
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Affiliation(s)
- Julie Antomarchi
- Université Nice Côte d'Azur, CHU Nice-Archet II, Service Gynécologie Obstétrique, Nice, France,
| | - Daniel Moeglin
- Université Nice Côte d'Azur, CHU Nice-Archet II, Service Gynécologie Obstétrique, Nice, France
| | | | - Danièle Combourieu
- Hôpital Femme-Mère-Enfants, Centre Pluridisciplinaire Diagnostic Prénatal, Lyon-Bron, France
| | - Nicole Bigi
- CRHU Carémeau-Nîmes, Service Gynécologie Obstétrique, Nîmes, France
| | - Emeline Maisonneuve
- Université Pierre et Marie Curie, Hôpital Armand-Trousseau, Service de Médecine Fœtale, Paris, France
| | - Pascale Legac
- CRHU Carémeau-Nîmes, Service Gynécologie Obstétrique, Nîmes, France
| | - Marc Althuser
- CHU Grenoble, Centre de Diagnostic Prénatal, Grenoble, France
| | - Jérome Delotte
- Université Nice Côte d'Azur, CHU Nice-Archet II, Service Gynécologie Obstétrique, Nice, France
| | - Jean-Marie Jouannic
- Université Pierre et Marie Curie, Hôpital Armand-Trousseau, Service de Médecine Fœtale, Paris, France
| | - André Bongain
- Université Nice Côte d'Azur, CHU Nice-Archet II, Service Gynécologie Obstétrique, Nice, France
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Liaw A, Cunha GR, Shen J, Cao M, Liu G, Sinclair A, Baskin L. Development of the human bladder and ureterovesical junction. Differentiation 2018; 103:66-73. [PMID: 30236462 DOI: 10.1016/j.diff.2018.08.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 11/13/2022]
Abstract
The urinary bladder collects urine from the kidneys and stores it until the appropriate moment for voiding. The trigone and ureterovesical junctions are key to bladder function, by allowing one-way passage of urine into the bladder without obstruction. Embryological development of these structures has been studied in multiple animal models as well as humans. In this report we review the existing literature on bladder development and cellular signalling with particular focus on bladder development in humans. The bladder and ureterovesical junction form primarily during the fourth to eighth weeks of gestation, and arise from the primitive urogenital sinus following subdivision of the cloaca. The bladder develops through mesenchymal-epithelial interactions between the endoderm of the urogenital sinus and mesodermal mesenchyme. Key signalling factors in bladder development include shh, TGF-β, Bmp4, and Fgfr2. A concentration gradient of shh is particularly important in development of bladder musculature, which is vital to bladder function. The ureterovesical junction forms from the interaction between the Wolffian duct and the bladder. The ureteric bud arises from the Wolffian duct and is incorporated into the developing bladder at the trigone. It was previously thought that the trigonal musculature developed primarily from the Wolffian duct, but it has been shown to develop primarily from bladder mesenchyme. Following emergence of the ureters from the Wolffian ducts, extensive epithelial remodelling brings the ureters to their final trigonal positions via vitamin A-induced apoptosis. Perturbation of this process is implicated in clinical obstruction or urine reflux. Congenital malformations include ureteric duplication and bladder exstrophy.
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Affiliation(s)
- Aron Liaw
- Department of Urology, University of California, San Francisco, San Francisco, CA Division of Pediatric Urology, University of California San Francisco Benioff Children's Hospital, San Francisco, CA 94143, United States
| | - Gerald R Cunha
- Department of Urology, University of California, San Francisco, San Francisco, CA Division of Pediatric Urology, University of California San Francisco Benioff Children's Hospital, San Francisco, CA 94143, United States
| | - Joel Shen
- Department of Urology, University of California, San Francisco, San Francisco, CA Division of Pediatric Urology, University of California San Francisco Benioff Children's Hospital, San Francisco, CA 94143, United States
| | - Mei Cao
- Department of Urology, University of California, San Francisco, San Francisco, CA Division of Pediatric Urology, University of California San Francisco Benioff Children's Hospital, San Francisco, CA 94143, United States
| | - Ge Liu
- Department of Urology, University of California, San Francisco, San Francisco, CA Division of Pediatric Urology, University of California San Francisco Benioff Children's Hospital, San Francisco, CA 94143, United States
| | - Adriane Sinclair
- Department of Urology, University of California, San Francisco, San Francisco, CA Division of Pediatric Urology, University of California San Francisco Benioff Children's Hospital, San Francisco, CA 94143, United States
| | - Laurence Baskin
- Department of Urology, University of California, San Francisco, San Francisco, CA Division of Pediatric Urology, University of California San Francisco Benioff Children's Hospital, San Francisco, CA 94143, United States.
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Fishel-Bartal M, Perlman S, Messing B, Bardin R, Kivilevitch Z, Achiron R, Gilboa Y. Early Diagnosis of Bladder Exstrophy: Quantitative Assessment of a Low-Inserted Umbilical Cord. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1801-1805. [PMID: 28436540 DOI: 10.1002/jum.14212] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 11/08/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Bladder exstrophy is a rare severe congenital malformation. Early prenatal diagnosis is scarcely described in the literature. Low insertion of the umbilical cord is a constant anatomic feature of bladder exstrophy. The aim of our study was to assess whether early measurements of the umbilical cord insertion-to-genital tubercle length may serve as quantitative measurements for a low-inserted umbilical cord in cases of bladder exstrophy. METHODS The umbilical cord insertion-to-genital tubercle length was prospectively measured in all cases referred for a nonvisualized urinary bladder before 18 weeks' gestation. Final diagnoses were compared with prenatal measurements. RESULTS Fifteen fetuses were evaluated for a nonvisualized bladder at a mean gestational age of 15.7 weeks (range, 14-17 weeks). Of them, 6 cases were diagnosed with bladder exstrophy, and 9 cases had a normal urinary bladder. All cases with bladder exstrophy had an umbilical cord insertion-to-genital tubercle length below the fifth percentile for gestational age, whereas cases with a normal bladder had a normal measurement. CONCLUSIONS Fetuses with bladder exstrophy have an umbilical cord insertion-to-genital tubercle length below the fifth percentile of the general population. This measurement may serve as a complementary objective sonographic parameter in the prenatal assessment and counseling of cases suspected of having bladder exstrophy during early pregnancy.
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Affiliation(s)
- Michal Fishel-Bartal
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sharon Perlman
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Baruch Messing
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ron Bardin
- Ultrasound Unit, Department of Obstetrics and Gynecology, Rabin Medical Center, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Zvi Kivilevitch
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Reuven Achiron
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yinon Gilboa
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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da Cruz JAS, de Mattos B, Srougi M, Nguyen H, Bonan R, Denes F, Giron A, Passerotti C. Quality of life in young adult patients treated for bladder exstrophy. Cent European J Urol 2016; 69:221-4. [PMID: 27551562 PMCID: PMC4986295 DOI: 10.5173/ceju.2016.715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 03/01/2016] [Accepted: 03/06/2016] [Indexed: 11/23/2022] Open
Abstract
Introduction Bladder exstrophy (BE) is a rare condition that requires complex surgical corrections to achieve the goals of bladder functionality, normal sexual function, continence, and finally cosmesis. The purpose of this study was to identify clinical parameters that predict better quality of life (QOL) scores using a validated questionnaire (SF-36) with young adults after completing surgical reconstruction. Material and methods Forty-three young adults (mean age 22.35 years, 29 men and 14 women) treated for BE were evaluated using the Short Form 36 general health questionnaire (SF-36). Clinical assessment involved evaluation of the actual condition regarding continence, sexual function, genital satisfaction and overall cosmesis. Results Both genders presented similar QOL scores (p = 0.36). The QOL was not age-related (p = 0.63). Neither genders did not present any differences in the number of procedures (p = 0.27). Although no significant gender difference was found, clinical impairments – such as urinary fistula, incontinence, penile length and infertility – were associated with worse QOL scores and were male-related (p <0.01). The most common complaint after complete surgical repair was about penile length (26/29 patients, 89.6%). Conclusions Age and gender were not predictors of better QOL scores. Any clinical impairment, such as urinary leakage due to incontinence or fistula, penile length and infertility, tended to significantly decrease the overall QOL in male patients with BE. The male genitalia seems to be the most troublesome aspect post-adolescence in treated male patients with exstrophy-epispadias. It has an important impact on the overall QOL, mainly having a social affect on those patients.
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Affiliation(s)
| | - Bruno de Mattos
- Laboratory of Medical Research, Urology - LIM 55, University of Sao Paulo, Department of Urology, Sao Paulo, Brazil
| | - Miguel Srougi
- Laboratory of Medical Research, Urology - LIM 55, University of Sao Paulo, Department of Urology, Sao Paulo, Brazil
| | - Hiep Nguyen
- Cardon Children Medical Center, Arizona, United States
| | - Rafael Bonan
- Laboratory of Medical Research, Urology - LIM 55, University of Sao Paulo, Department of Urology, Sao Paulo, Brazil
| | - Francisco Denes
- Laboratory of Medical Research, Urology - LIM 55, University of Sao Paulo, Department of Urology, Sao Paulo, Brazil
| | - Amilcar Giron
- Center of Robotic Surgery, German Hospital Oswaldo Cruz, Sao Paulo, Brazil
| | - Carlo Passerotti
- Center of Robotic Surgery, German Hospital Oswaldo Cruz, Sao Paulo, Brazil
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Kolarova J, Bens S, Ammerpohl O, Hilger AC, Zhang R, Reutter H, Siebert R. PLAGL1epimutation and bladder exstrophy: Coincidence or concurrent etiology? ACTA ACUST UNITED AC 2016; 106:724-8. [DOI: 10.1002/bdra.23521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/11/2016] [Accepted: 04/19/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Julia Kolarova
- Institute of Human Genetics; Christian-Albrechts-University Kiel; Kiel Germany
- Institute of Human Genetics; University of Ulm; Ulm Germany
| | - Susanne Bens
- Institute of Human Genetics; Christian-Albrechts-University Kiel; Kiel Germany
- Institute of Human Genetics; University of Ulm; Ulm Germany
| | - Ole Ammerpohl
- Institute of Human Genetics; Christian-Albrechts-University Kiel; Kiel Germany
| | - Alina C. Hilger
- Institute of Human Genetics; University of Bonn; Bonn Germany
| | - Rong Zhang
- Institute of Human Genetics; University of Bonn; Bonn Germany
| | - Heiko Reutter
- Institute of Human Genetics; University of Bonn; Bonn Germany
- Department of Neonatology and Pediatric Intensive Care; Children's Hospital, University of Bonn; Bonn Germany
| | - Reiner Siebert
- Institute of Human Genetics; Christian-Albrechts-University Kiel; Kiel Germany
- Institute of Human Genetics; University of Ulm; Ulm Germany
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