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Yahya MH. Bladder Agenesis: A Systematic Review. Cureus 2023; 15:e45121. [PMID: 37842406 PMCID: PMC10569670 DOI: 10.7759/cureus.45121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2023] [Indexed: 10/17/2023] Open
Abstract
Bladder agenesis is a rare congenital deformity characterized by the absence of the bladder. It is primarily observed in postmortem dissections of stillbirths rather than live births. The condition is often associated with other congenital anomalies, leading to the hypothesis that most affected fetuses do not survive to term. However, the exact cause and specific associated anomalies remain unclear and poorly described in the literature. The limited mention of bladder agenesis in textbooks and literature underscores the importance of creating a comprehensive source for future research in this field. Therefore, our objective is to collect and analyze data on bladder agenesis, focusing on associated anomalies and potential causes, to enhance our understanding of the condition. We conducted a thorough review of reports collected from three databases, Google Scholar, PubMed, and Science Direct, last searched on July 30, 2023, starting with 327 reports. Excluding duplicates and records written in languages other than English, veterinary studies, irrelevant reports, or stillbirths. Inclusion criteria were the following: cases must have proven bladder agenesis, not hypoplasia, and must have most of the information, including the age of diagnosis, presenting symptoms, gender, associated anomalies, and management or outcome of the patient. A quality assessment was conducted according to the Joanna Briggs Institute checklist for case reports. A total of 65 case reports from 56 articles were included in the review. Through our manual analysis, we documented a wild array of malformations associated with bladder agenesis. Among the reports reviewed, 93% exhibited urinary system malformations beside bladder agenesis, 77% were found to have reproductive malformations, 44% had gastrointestinal anomalies, 38% showed musculoskeletal malformations, 28% had cardiac malformations, and another 28% had vascular anomalies. The overall mortality rate was 38%, with a higher rate of 74% for males compared to 20% for females. By collating and analyzing those case reports, we aim to contribute to a better understanding of bladder agenesis and its associated anomalies, facilitating further investigations and advancements in the field.
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Cao KX, Milmoe NJ, Cuckow PM, Olsen LH, Johal NS, Douglas Winyard PJ, Long DA, Fry CH. Antenatal biological models in the characterization and research of congenital lower urinary tract disorders. J Pediatr Urol 2021; 17:21-29. [PMID: 33386226 DOI: 10.1016/j.jpurol.2020.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 11/02/2020] [Accepted: 11/12/2020] [Indexed: 11/26/2022]
Abstract
Congenital lower urinary tract disorders are a family of diseases affecting both urinary storage and voiding as well as upstream kidney function. Current treatments include surgical reconstruction but many children still fail to achieve urethral continence or progress to chronic kidney disease. New therapies can only be achieved through undertaking research studies to enhance our understanding of congenital lower urinary tract disorders. Animal models form a critical component of this research, a corner of the triangle composed of human in-vitro studies and clinical research. We describe the current animal models for two rare congenital bladder disorders, posterior urethral valves (PUV) and bladder exstrophy (BE). We highlight important areas for researchers to consider when deciding which animal model to use to address particular research questions and outline the strengths and weaknesses of current models available for PUV and BE. Finally, we present ideas for refining animal models for PUV and BE in the future to stimulate future researchers and help them formulate their thinking when working in this field.
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Affiliation(s)
- Kevin Xi Cao
- Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, University College London, London, WC1N 1EH, UK; Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK.
| | - Nathalie Jane Milmoe
- Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, University College London, London, WC1N 1EH, UK.
| | - Peter Malcom Cuckow
- Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK.
| | - Lars Henning Olsen
- University of Aarhus, Palle Juul-Jensens Boulevard 35, 8200 Aarhus, Denmark.
| | - Navroop Singh Johal
- University of Aarhus, Palle Juul-Jensens Boulevard 35, 8200 Aarhus, Denmark.
| | - Paul Julian Douglas Winyard
- Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, University College London, London, WC1N 1EH, UK.
| | - David Andrew Long
- Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, University College London, London, WC1N 1EH, UK.
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Mc Laughlin D, Hajduk P, Murphy P, Puri P. Adriamycin-Induced Models of VACTERL Association. Mol Syndromol 2013; 4:46-62. [PMID: 23653576 DOI: 10.1159/000345579] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Animal models are of great importance for medical research. They have enabled analysis of the aetiology and pathogenesis of complex congenital malformations and have also led to major advances in the surgical and therapeutic management of these conditions. Animal models allow us to comprehend the morphological and molecular basis of disease and consequently to discover novel approaches for both surgical and medical therapy. The anthracycline antibiotic adriamycin was incidentally found to have teratogenic effects on rats, producing a range of defects remarkably similar to the VACTERL association of congenital anomalies in humans, providing a reproducible animal model of this condition. VACTERL association is a spectrum of birth defects which includes vertebral, anal, cardiovascular, tracheo-oesophageal, renal and limb anomalies. In recent years, adriamycin rodent models of VACTERL have provided valuable insights into the pathogenesis of this complex association, particularly in relation to tracheo-oesophageal malformations. The adriamycin rat model and adriamycin mouse model are now well established in the investigation of the morphology of faulty organogenesis and the regulation of gene expression in tracheo-oesophageal anomalies.
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Affiliation(s)
- D Mc Laughlin
- National Children's Research Centre, Our Lady's Children's Hospital, Dublin, Ireland ; Children's University Hospital, Dublin, Ireland ; School of Natural Sciences, Trinity College Dublin, Dublin, Ireland
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Chen CY, Tsao TF, Chang HM, Chen SL, Chen SM, Hung TW, Lue KH, Sheu JN. Bladder agenesis and bilateral ectopic ureters draining into the vagina in a female infant: demonstrated by MR imaging. Surg Radiol Anat 2011; 34:89-92. [PMID: 21688139 DOI: 10.1007/s00276-011-0838-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 06/02/2011] [Indexed: 11/24/2022]
Abstract
Complete agenesis of the bladder and urethra is an extremely rare congenital anomaly and most of these patients are stillborn or die during infancy. We report the case of a 1-month-old female infant with bladder and urethral agenesis who presented with bilateral dilated and tortuous ectopic ureters draining into the vagina diagnosed using MR imaging. Our patient was maintained on antibiotic prophylaxis and she remained well during the 3-year follow-up. MR imaging can be used as a valuable modality for genitourinary abnormalities, particularly in cases of inconclusive ultrasound or retrograde pyelography findings.
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Affiliation(s)
- Chih-Yi Chen
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, 402, Taiwan
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Melidone R, Parry NMA, Gruntman A. Urinary bladder agenesis in an alpaca (Vicugna pacos) cria. J Vet Diagn Invest 2010; 22:473-5. [PMID: 20453232 DOI: 10.1177/104063871002200327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 10-day-old female alpaca (Vicugna pacos) cria with a history of urinary straining and dribbling was presented for evaluation. The animal had markedly elevated blood fibrinogen (800 mg/dl), mildly elevated phosphorus (9.3 mg/dl), and minimally elevated blood urea nitrogen (38 mg/dl) concentrations. The total protein (5.0 g/dl) concentration was mildly decreased. These findings were suggestive of mild renal disease. An abdominal ultrasound revealed bilateral hydronephrosis and hydroureter, and no urinary bladder was identified. Gross postmortem examination revealed urinary bladder agenesis and bilateral hydronephrosis and hydroureter, with both ureters opening into a sinus in the caudal vagina. Histologic examination of the kidneys showed necrosuppurative pyelonephritis with pelvic dilation, and both ureters had mild lymphoplasmacytic and histiocytic inflammation.
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Affiliation(s)
- Raffaele Melidone
- Tufts Cumming School of Veterinary Medicine-Pathology, 200 Westborough Road, North Grafton, MA 01536, USA.
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Yurtçu M, Gürbüzer N, Findik S, Avunduk MC, Günel E. Investigation of histopathologic changes in the ureter walls in vesicoureteral reflux. J Pediatr Surg 2009; 44:802-5. [PMID: 19361644 DOI: 10.1016/j.jpedsurg.2008.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Revised: 07/14/2008] [Accepted: 08/12/2008] [Indexed: 11/16/2022]
Abstract
PURPOSE This study aimed to determine the histopathologic changes in ureteral walls (UWs) in children with vesicoureteral reflux (VUR). METHODS Twenty ureteral specimens taken from children were divided into 2 groups, refluxing (R) and control (C) groups, each containing 10 specimens. Wall thickness of the ureter, tunica muscularis of the ureter, mucosal thickness of the ureter (uroepithelium), collagen thickness of the ureter, mucosal change, and inflammation were evaluated in resected distal UWs in children with VUR. RESULTS The mean wall thickness of the ureter, mean tunica muscularis of the ureter, and mean uroepithelium values of the UWs in the R group were not significantly lower compared to those in the C group. Collagen thickness values in the R group were significantly lower than those in the C group. CONCLUSIONS Our data suggest that wall thickness (tunica muscularis and uroepithelium) was not significantly decreased, but collagen thickness of the ureter was decreased in the UWs of children with VUR.
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Affiliation(s)
- Müslim Yurtçu
- Department of Pediatric Surgery, Meram Medical School of Selcuk University, Konya, Turkey.
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Investigation of histopathologic changes in the ureter walls in experimental congenital obstructive uropathy. J Pediatr Surg 2008; 43:1524-7. [PMID: 18675646 DOI: 10.1016/j.jpedsurg.2007.11.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 11/07/2007] [Accepted: 11/17/2007] [Indexed: 11/20/2022]
Abstract
BACKGROUND/PURPOSE The aim of this study is to determine the histopathologic changes in the ureter wall in experimental urinary bladder hypoplasia and agenesis. METHODS Timed pregnant rats were randomly divided and received intraperitoneal Adriamycin (ADR) at 2 mg/kg on gestational days (GD) 6 to 9 (ADR group) and saline at 2 mL/kg on GD 6 to 9 (SF group). The control (C) group did not receive any medication in their pregnancy. Fetuses were harvested near term on GD 21 and dissected under a dissecting microscope and examined for urinary system abnormalities. RESULTS Diameter of ureter lumen was significantly increased, but wall thickness, tunica muscularis, and epithelial thickness of the ureter were decreased in the ADR group as compared with the C and SF groups. CONCLUSIONS Diameter of the ureter lumen was increased, but wall thickness, tunica muscularis, and uroepithelium of the ureter were decreased in the ADR group in the intrauterine period. The diameter of the ureter lumen and wall thickness of ureter (tunica muscularis of ureter and uroepithelium) were increased following obstructive uropathy after the birth.
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Abstract
The teratogenic effect of Adriamycin (doxorubicin) in the rat model, and more recently in the mouse, has provided paediatric surgeons with a reliable, easily reproducible method of studying the embryology and molecular biology for a range of complex congenital anomalies. Concomitantly these animal models have stimulated interest among embryologists for the effect on the notochord, shedding more light on the important organizational role of this structure in the developing embryo. Finally, as more is learnt of the pathogenesis of the various malformations induced by Adriamycin, future therapeutic interventions involving gene therapy, drugs or surgery may arise. This article reviews the establishment of the Adriamycin rat and mouse models, examines their impact on various congenital malformations, and suggests targets for further research.
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Affiliation(s)
- A Mortell
- Children's Research Centre, Our Lady's Hospital for Sick Children, Crumlin, Dublin 12, Ireland
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Mortell A, Fourcade L, Solari V, Puri P. Bilateral megaureters in the Adriamycin rat model. Pediatr Surg Int 2005; 21:212-6. [PMID: 15578190 DOI: 10.1007/s00383-004-1322-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2004] [Indexed: 10/26/2022]
Abstract
Congenital obstructive uropathy is associated with significant morbidity and mortality in the human neonate. The pathophysiology of congenital obstructive uropathy is poorly understood. There are very few experimental models of prenatal obstruction of the urinary tract, except in the fetal lamb or inbred rats. Prenatal exposure to Adriamycin in a rat model leads to a spectrum of malformations including urinary tract anomalies. We hypothesized that Adriamycin administration during a particular time frame could yield a high incidence of urinary tract anomalies and therefore designed this study to investigate the rates of urinary tract anomalies at different windows of Adriamycin injection in rat embryos. Adriamycin (1.75 mg/kg) was administered intraperitoneally to pregnant rats at different times from days 6 to 10 of gestation. Control animals were given saline. Embryos recovered on gestational day 21 by cesarean section were examined for urinary tract anomalies, and malformations were noted. Sections were then processed for paraffin embedding, sectioned at 5 mum, and stained with hematoxylin and eosin for histological examination. Anomalies of the urinary tract occurred maximally following Adriamycin administration on days 7, 8, and 9 of gestation (91.6%) compared with 16% of controls. The most common urinary tract anomaly in the Adriamycin group was bilateral megaureters with a hypoplastic bladder (81%). Other anomalies included unilateral or bilateral ureterohydronephrosis with a normal-sized bladder, duplex kidney, and unilateral or bilateral renal agenesis. In conclusion, the critical embryologic window for the development of bilateral megaureters with a small bladder in the Adriamycin rat model occurs following Adriamycin administration on gestational days 7-9. This simple experimental model of bilateral megaureter may allow further research into the pathophysiology of this condition.
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Affiliation(s)
- A Mortell
- The Children's Research Centre, Our Lady's Hospital for Sick Children, Crumlin, Dublin 12, Ireland
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