Bladder exstrophy is a birth defect where the bladder and abdominal wall do not close properly in the womb, leaving the bladder exposed. It occurs in about 1 in 3,000 births and is more common in males. Risk factors include young maternal age and exposure to high doses of progesterone during the first trimester. Clinically, the abdominal wall is absent and the bladder lining is exposed and bright red. Surgical correction is required to repair the abdominal wall and close the bladder. Long term risks include incontinence, infection, and rarely cancer due to changes in the bladder lining.

1. BLADDER EXSTROPHY
Prepaired by MD/3/15/121/TZ

2. CONTENTS
1. Introduction
2. Epidemiology
3. Etiology- Risk Factors
4. Pathology
5. Clinical features- Symptoms & Signs
6. Differential diagnosis
7. Investigations
8. Treatment

3. ANATOMY OF URINARY BLADDER
 It is a muscular reservoir of urine situated in the
pelvis, posterior to the pubic bone separated by the
retro-pubic space.
 The size, shape, position of bladder vary depends on
amount of urine it contains
 Made up of detrusor and trigone muscles
 The neck of bladder is of 3-4 cm

4. DIAGRAMATIC VIEW

5. BLOOD SUPPLY
 Superior vesical artery, a branch of internal iliac
artery.
 Inferior vesical artery.
 – Venous drainage is by the vesical plexus of veins,
which drains into the internal iliac veins.

6. INNERVATION AND LYMPHATIC DRAINAGE
 Lymphatics drain into internal iliac and external iliac
nodes.
 The efferent parasympathetic fibres (S2-S4):
contraction of the detrusor muscle and relaxation of
the sphincter vesicae.
 The sympathetic input, this arises in the 11th
thoracic to the second lumbar segments;

7. By definition:is defined as incomplete development of
the infraumbilical part of the anterior abdominal
wall and anterior wall of the bladder .
This is one among the commonest congenital
abnormality lower urinary and genital track

8. EPIDERMIOLOGY
Occurring approximately 1/3000 of all child birth
Males are more often affected than females by the
ratio is 5 : 1 to 6:1

9. RISK FACTORS
It occurs in infants of young mother
Inrease 10 folds to those mothers who received high
dose of progestrone during the first trimester

10. PATHOPHYSIOLOGY
 Abnormal large cloacal membrane prevents the
mesodermal to growth and lower abdominal midline
fusion. So when the cloacal membrane rupture the
anterior abdominal wall,pubis,bladder and urethra
fail to develop normally

11. TYPES
There are two types
1.complete
2. incomlete:
the pubic bones are united and the external
genitalia normal or there is epispadias.

12. CLINICAL PRESENTATION
 Anterior abdominal wall absent
 Posterior bladder linning which is bright red color is
exposed
 Urine seeps into the posterior bladder wall from
abnormal ureteral outlets
 At time of birth the mucosa of bladder may be thin
and smooth but it is later become edemetous

13. ASSOCIATED ANOMALIES:
1. The rami of pubic bones are widely separated.
There is a thick fibrous band. The femurs are rotated
externally and the child waddles like a duck
(waddling gait).
2. The umbilicus is absent. There may be umbilical
hemia.

14. 3. Genitalia.—
(a) In the males :
(i) Epispadias is almost always present.
(ii) The penis is broader and shorter than normal. It is
drawn up and fixed to the abdominal wall.
(iii) The scrotum may be ill-developed.
(iv) The testes may be normal or ectopic or
maldescended.
(v) The prostate and seminal vesicles are often
rudimentary or absent.

15. (b) In the females :
(i) The clitoris is usually cleft.
(ii) The labia minora are separated.
(iii) There may be anomalies in the development of
uterus and vagina.
4. Anal sphincter is often lax.
5. Hernia :
(a) Umbilical hernia may be present.
(b) There may be inguinal hernia of one or both
sides

16. COMPLICTIONS
Hemorrhage
Ulceration
Pain
Recurrent pyelonephritis
Renal failure
Metaplastic changes in mucosa can lead into
adenocarcinoma
50% of patients die of renal failure

17. DIAGNOSIS
1 Diagnosis: can be confirmed before delivery via uss
and or MRI. Also clinically
2 Diffential diagnosis:
patent urachus

18. INVESSTIGATION
 prenatal USS:
 include a lower abdominal wall mass,
 absent bladder filling,
 low-set umbilicus,
 small genitalia,
 abnormal iliac crest widening.
 Diagnosis can help planning of delivery in a centre
with facilities to perform early surgical correction.

19. MANEGEMENT
 At birth:
cover the bladder with plastic fi lm and irrigate
regularly with sterile saline.
 Surgical:
Newborn:
pelvic osteotomy (cutting bone to correct deformity)
with external fixation and closure of bladder,
abdominal wall, and posterior urethra.

20.  6–18 months: epispadias repair
 4–5yrs: bladder neck reconstruction (Young– Dees–
Leadbetter procedure) and anti-reflux surgery
(ureteric re-implantation)is performed when there is
adequate bladder capacity and children can
participate in voiding protocols. Where bladder
capacity is too small, bladder augmentation and/or
urinary diversion is required

21. SURGICAL COMPLICATION
 :increased risk of malignancy in urinary or
orthotopic bladder
 fistula
 hypospadias
 bladder stones
 infection (UTI, epididymitis)
 incontinence

22. AHSANTENI THANKS
VERY MUCH
FOR ALL
THANKS AHSANTENI