New Insights on the Basic Science of Bladder Exstrophy-epispadias Complex

The outcome and complications of modern staged repair surgery in newborns with classic bladder exstrophy in different genders: A retrospective study

INTRODUCTION

Classic bladder exstrophy (CBE) is a rare anterior midline birth defect that remains a challenge for pediatric surgeons. Despite multiple reconstructive methods, outcomes vary widely in various reports. This study aims to compare the success rate and complications of modern staged repair of exstrophy (MSRE) in each gender and compare together.

METHODS

This retrospective cross-sectional study included cases of CBE between 2010 and 2020 that underwent MSRE. Short-term follow-up results, including incontinence rate, vesicoureteral reflux (VUR), urinary infections, deformed genitalia, and so on, were measured in each gender, and their differences were reported.

RESULTS

Among the 40 newborns with CBE who underwent MSRE, 25 (62.5%) were boys, while the others had non-male genitalia. The rates of incontinence, VUR, dehiscence, and fistulas did not differ significantly between genders. However, chronic urinary tract infections (UTIs) were more frequent in girls, and boys were more likely to have malformed genitalia (p < .05).

CONCLUSION

Our findings indicate a similar rate of complications in each gender. However, chronic UTIs and external genitalia deformities were significantly more common in girls and boys, respectively. Further large-sized controlled trials may be needed to corroborate these findings.

Prenatal Diagnosis of Bladder Exstrophy and OEIS over 20 Years

OBJECTIVE

To examine the prenatal diagnosis rates of bladder exstrophy (BE) and Omphalocele-Exstrophy-Imperforate anus-Spinal Defect Syndrome (OEIS) in a large cohort of patients over a 20-year period. We hypothesized that prenatal diagnosis rates improved over time due to evolving techniques in fetal imaging.

METHODS

A multi-institutional database was queried to identify BE or OEIS patients who underwent primary closure between 2000 and 2020. We retrospectively determined prenatal or postnatal diagnosis. Those with unknown prenatal history were excluded. Multivariable logistic regression was used to investigate temporal pattern in rate of prenatal diagnosis while adjusting for sex and treating institution.

RESULTS

Among 197 BE and 52 OEIS patients, 155 BE and 45 OEIS patients had known prenatal history. Overall prenatal diagnosis rates of BE and OEIS were 47.1% (73/155) and 82.2% (37/45), respectively. Prenatal diagnosis rate was significantly lower in BE compared to OEIS (P <.0001). The prenatal diagnosis rate for BE significantly increased over time (OR 1.10; [95%CI: 1.03-1.17]; P = .003). Between 2000 and 2005, the prenatal diagnosis rate of BE was 30.3% (10/33). Between 2015 and 2020, prenatal diagnosis rate of BE was 61.1% (33/54). Prenatal diagnosis rate for OEIS did not change over time. Rates of prenatal diagnosis did not differ by sex or treating institution.

CONCLUSION

Rates of prenatal diagnosis of BE and OEIS are higher than previously reported. Prenatal diagnosis rate of BE doubled in the last 5 years compared to the first 5 years of the study period. Nonetheless, a significant proportion of both BE and OEIS patients remain undiagnosed prior to delivery.

A Triplicated Bladder with Diphallia; Rare Variant of Duplicate Exstrophy

Background

Exstrophy variants are well described urologic anomalies. They are characterized by atypical anatomical and physical findings than those found in patients with classic bladder exstrophy and epispadias malformation. The combination of these anomalies with duplicated phallus is a rare occurrence. Here we present a neonate with a rare form of exstrophy variant associated with penile duplication.

Case Summary

One day old male neonate who was born at term was admitted to our neonatal intensive care unit. He had lower abdominal wall defect and open bladder plate with no visible ureteric orifices. There were two completely separate phalluses with penopubic epispadias and urethral orifices draining urine. Both testes were descended. Abdominopelvic ultrasound showed normal upper urinary tract. He was prepared and operated with intra operative finding of complete bladder duplication in the sagittal plane and each bladder has its own ureter. The open bladder plate which had no connection with both ureters and urethras was excised. The pubic symphysis was approximated without osteotomy and abdominal wall was closed. He was immobilized with mummy wrap. He had uneventful post-operative course and was discharged on the 7th post-operative day. He was evaluated on the 3rd month post operatively and he was thriving well with no complications.

Conclusion

The occurrence of a triplicated bladder along with diphallia is an exceptionally rare urologic anomaly. As a number of variations are possible in this spectrum, the management of neonates with this anomaly should be individualized.