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Rasouli E, Wahdat A, Nazari MJ. Isolated bladder exstrophy with normal phallus and imperforated anus: "A case report". Urol Case Rep 2024; 55:102755. [PMID: 38868626 PMCID: PMC11167431 DOI: 10.1016/j.eucr.2024.102755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 05/17/2024] [Accepted: 05/21/2024] [Indexed: 06/14/2024] Open
Abstract
This case report presents a rare occurrence of isolated bladder exstrophy with a normal phallus in a one-day-old male newborn. The patient also presented with imperforated anus, congenital heart disease, and a left ectopic kidney. Surgical interventions included cut-back anoplasty, bilateral ureteral reimplantation, and primary bladder closure in a single operation, resulting in a successful outcome without complications. Three months of follow-up showed satisfactory results.
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Affiliation(s)
- Ehsanullah Rasouli
- Department of Pediatric Surgery, Aria Apollo Specialty Hospital, Herat, Afghanistan
| | - Abdullah Wahdat
- Department of Pediatric Surgery, Aria Apollo Specialty Hospital, Herat, Afghanistan
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Modekwe VI, Ekwunife OH, Ugwu JO, Ugwunne CA, Ndukwu CU, Obiegbu HO, Obidike AB. Classical bladder exstrophy in an adolescent: A case report on management, challenges and outcome. Afr J Paediatr Surg 2023; 20:233-237. [PMID: 37470562 PMCID: PMC10450118 DOI: 10.4103/ajps.ajps_172_21] [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: 12/07/2021] [Revised: 04/18/2022] [Accepted: 06/10/2022] [Indexed: 01/22/2023] Open
Abstract
Classical bladder exstrophy is a congenital anomaly whose management and outcome has advanced over years. Management and outcome are better when management starts at the newborn period. This was the management of a neglected bladder exstrophy in a male presenting at 16 years of age. We report our challenges, management and outcome to highlight the rarity of this presentation, and the adaptation to the usual protocol of care. The patient presented at 16 years of age with classic bladder exstrophy. The bladder plate was contracted and had cystitis. The patient had a modification of complete primary repair of exstrophy (CPRE) with bilateral pelvic osteotomy stabilised with a 7-hole plate and 4 screws, then bladder neck reconstruction + bladder augmentation + cross-trigonal neocystoureterostomy in a 12-h procedure. He had surgical site infection, superficial wound breakdown and vesicocutaneous fistula that all healed with dressing and prolonged suprapubic cystostomy drainage. He achieved some degree of urinary continence and ability to void, though he still has stress incontinence and frequency at 6 months of follow-up. He has a micturition interval of 60-120 min, and is expected to improve. Presentation and repair of classic bladder exstrophy in the adolescent is very rare in the literature and therefore no known standard of care. This report adds to the body of knowledge. Again, this experience lends credence to the proponents of CPRE in reducing the number of procedures required to treat exstrophy.
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Affiliation(s)
- Victor Ifeanyichukwu Modekwe
- Department of Surgery, Nnamdi Azikiwe University Awka, Nigeria
- Department of Surgery, Paediatric Surgery Unit, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Okechukwu Hyginus Ekwunife
- Department of Surgery, Nnamdi Azikiwe University Awka, Nigeria
- Department of Surgery, Paediatric Surgery Unit, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Jideofor Okechukwu Ugwu
- Department of Surgery, Nnamdi Azikiwe University Awka, Nigeria
- Department of Surgery, Paediatric Surgery Unit, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Chuka Abunike Ugwunne
- Department of Surgery, Paediatric Surgery Unit, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Chibuzo Uchechukwu Ndukwu
- Department of Surgery, Nnamdi Azikiwe University Awka, Nigeria
- Department of Orthopaedics, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Henry Obinna Obiegbu
- Department of Surgery, Nnamdi Azikiwe University Awka, Nigeria
- Department of Orthopaedics, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Afam Ben Obidike
- Department of Anaesthesia, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
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Zulfiqar Y, Myh E, Yusrawati Y, Serudji J, Wahyudi I, Rodjani A. Delivery in a Female Bladder Exstrophy Patient With Ileal W Pouch Continent Cutaneous Stoma. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Propose: To deliver a case report of female bladder exstrophy patients who experienced pregnancy until the birth process.
Methods: A 28-year-old woman with a history of bladder exstrophy, which received inadequate treatment during childhood, had bladder shrinkage and uterine prolapse. The patient underwent reconstruction of continent cutaneous stoma and sacrocolpopexy with mesh in her adulthood. She achieved complete continence by intermittent self-catheterization and gained a better quality of life. She later got married and became pregnant. Pregnancy monitoring was done to evaluate the condition of the patient and her fetus. A collaborative team was built to discuss the best option for delivering the procedure. At 38–39 weeks of gestational age, an elective cesarian section was performed to deliver the baby.
Results: Despite having a greater risk of complications, a woman with a history of bladder exstrophy could undergo pregnancy and give birth. The choice of delivery, either vaginal or cesarean section, is feasible for delivery.
Conclusions: An adult female with bladder exstrophy underwent pregnancy and gave birth. Prior surgery and increased risk of obstetrical complications must be considered.
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Suastari NMP, Margiani NN, Santosa KB, Mahiswara DG, Sitanggang FP, Yudiana IW. Management of bladder exstrophy in an adolescent girl: a case report. MEDICAL JOURNAL OF INDONESIA 2021. [DOI: 10.13181/mji.cr.215249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Bladder exstrophy (BE) is a very rare congenital abnormality, especially in girls. We reported a 17-year-old girl with protruded bladder and urinary incontinence. Her vaginal orifice appeared stenotic and shifted anteriorly. She had an incomplete labia minora, short perineum, and anterior displacement of the anus. The pelvic radiography showed a pubic diastasis with a manta ray sign, and the ultrasonography examination showed a bicornuate uterus. She had undergone a functional reconstruction surgery with cystectomy, ileal conduit, appendectomy, and vaginoplasty along with the advancement of abdominal flap reconstruction with multiple Z-plasty. Functionally, she was able to urinate through the ileal conduit comfortably, had a regular menstrual cycle with minimal pain, had a wider vaginal canal, and had a smooth blood flow. Aesthetically, she had a good lower abdomen appearance, remained dry, and had an odorless urine. In clinical practice, this rare case report can provide additional knowledge and management of the same cases with effective results.
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Tanacan A, Aktoz F, Fadiloglu E, Unal C, Beksac MS. A pregnant woman with an operated bladder extrophy and a pregnancy complicated by placenta previa and preterm labor. CASE REPORTS IN PERINATAL MEDICINE 2018. [DOI: 10.1515/crpm-2018-0008] [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]
Abstract
Abstract
Background
Bladder exstrophy (BE) is a complex congenital anomaly that affects the urinary, reproductive, musculoskeletal and intestinal systems.
Highlights
This pregnancy case was complicated by BE, methylenetetrahydrofolate reductase (MTHFR) A1298C and plasminogen Activator inhibitör-1 (PAI) 4G/4G homozygous polymorphisms, placenta previa, preterm labor and preterm premature rupture of the membranes. The fetus was evaluated by ultrasonography daily and anhydramnios was detected on the 2nd day of the patient’s hospitalization. A cesarean section (C/S) was performed at 27 weeks and 6 days of gestation and a 1330 g male infant was delivered.
Conclusions
Adult female patients with BE can have successful pregnancy outcomes if they receive appropriate antenatal care. However, the follow-up of these patients must be carried out at experienced tertiary reference centers with a multidisciplinary approach. This difficult process must be managed by obstetricians, neonatologists, urologists and pediatric surgeons working together.
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Sabetkish N, Sabetkish S, Kajbafzadeh AM. Preoperative care of Polypoid exposed mucosal template in bladder exstrophy: the role of high-barrier plastic wraps in reducing inflammation and polyp size. Int Braz J Urol 2018; 44:591-599. [PMID: 29368874 PMCID: PMC5996800 DOI: 10.1590/s1677-5538.ibju.2017.0196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 09/12/2017] [Indexed: 11/22/2022] Open
Abstract
Objective To assess the role of high-barrier plastic wrap in reducing the number and size of polyps, as well as decreasing the inflammation and allergic reactions in exstro- phy cases, and to compare the results with the application of low-barrier wrap. Materials and Methods Eight patients with bladder exstrophy-epispadias complex (BEEC) that had used a low density polyethylene (LDPE) wrap for coverage of the exposed polypoid bladder in preoperative care management were referred. The main complaint of their parents was increase in size and number of polyps. After a period of 2 months using the same wrap and observing the increasing pattern in size of polyps, these patients were recommended to use a high-barrier wrap which is made of polyvinylidene chloride (PVdC), until closure. Patients were monitored for the number and size of polyps before and after the change of barriers. The incidence of para-exstrophy skin infection/inflammation and skin allergy were assessed. Biopsies were taken from the polyps to identify histopathological characteristics of the exposed polyps. Results The high barrier wrap was applied for a mean ± SD duration of 12±2.1 months. Polyps' size and number decreased after 12 months. No allergic reaction was detected in patients after the usage of PVdC; three patients suffered from low-grade skin allergy when LDPE was applied. Also, pre-malignant changes were observed in none of the patients in histopathological examination after the application of PVdC. Conclusion Polyps' size and number and skin allergy may significantly decrease with the use of a high-barrier wrap. Certain PVdC wraps with more integrity and less evaporative permeability may be more “exstrophy-friendly”.
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Affiliation(s)
- Nastaran Sabetkish
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI)
| | - Shabnam Sabetkish
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI)
| | - Abdol-Mohammad Kajbafzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI)
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Valerio E, Vanzo V, Zaramella P, Salvadori S, Castagnetti M, Baraldi E. Exstrophy-Epispadias Complex in a Newborn: Case Report and Review of the Literature. AJP Rep 2015; 5:e183-7. [PMID: 26495181 PMCID: PMC4603851 DOI: 10.1055/s-0035-1556759] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 05/19/2015] [Indexed: 11/16/2022] Open
Abstract
Aim The aim of this report is to present a brief review of the current literature on the management of EEC. Case Report A term male neonate presented at birth with classic bladder exstrophy, a variant of the exstrophy-epispadias complex (EEC). The defect was covered with sterile silicon gauzes and waterproof dressing; at 72 hours of life, primary closure without osteotomy of bladder, pelvis, and abdominal wall was successfully performed. Discussion EEC incidence is approximately 2.15 per 1,00,000 live births; several urological, musculocutaneous, spinal, orthopedic, gastrointestinal, and gynecological anomalies may be associated to EEC. Initial medical management includes use of occlusive dressings to prevent air contact and dehydration of the open bladder template. Umbilical catheters should not be positioned. Surgical repair stages include initial closure of the bladder and abdominal wall with or without osteotomy, followed by epispadias repair at 6 to 12 months, and bladder neck repair around 5 years of life. Those who fail to attain continence eventually undergo bladder augmentation and placement of a catheterizable conduit. Conclusion Modern-staged repair of EEC guarantees socially acceptable urinary continence in up to 80% of cases; sexual function can be an issue in the long term, but overall quality of life can be good.
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Affiliation(s)
- Enrico Valerio
- Department of Woman and Child Health, Neonatal Intensive Care Unit, Medical School, University of Padua, Padova, Italy
| | - Valentina Vanzo
- Department of Woman and Child Health, Neonatal Intensive Care Unit, Medical School, University of Padua, Padova, Italy
| | - Patrizia Zaramella
- Department of Woman and Child Health, Neonatal Intensive Care Unit, Medical School, University of Padua, Padova, Italy
| | - Sabrina Salvadori
- Department of Woman and Child Health, Neonatal Intensive Care Unit, Medical School, University of Padua, Padova, Italy
| | - Marco Castagnetti
- Section of Pediatric Urology, Urology Unit, University Hospital of Padova, Padua, Italy
| | - Eugenio Baraldi
- Department of Woman and Child Health, Neonatal Intensive Care Unit, Medical School, University of Padua, Padova, Italy
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Etta OE, Ituen M. Perioperative Challenges in Repeat Bladder Exstrophy Repair - Case Report. Open Access Maced J Med Sci 2015; 3:432-5. [PMID: 27275265 PMCID: PMC4877834 DOI: 10.3889/oamjms.2015.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 07/08/2015] [Accepted: 07/09/2015] [Indexed: 11/05/2022] Open
Abstract
Bladder exstrophy is a rare congenital malformation. It presents as leakage of urine in the anterior abdominal wall following defects in midline anterior abdominal wall skin and bladder. We report the use of combined general anaesthesia and caudal epidural analgesia in a 4yr old boy for repeat bladder exstrophy repair. Problems of prolonged surgery and the challenges of pain and sedation management in the post operative period are discussed.
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Affiliation(s)
- Otu Enenyi Etta
- Department of Anaesthesia, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria
| | - Monday Ituen
- Paediatric Surgery Unit, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria
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