This document discusses bladder exstrophy, a birth defect where the bladder is exposed through an abdominal wall defect. It notes there are three types - epispadias, bladder exstrophy, and cloacal exstrophy - and lists signs and differences between males and females. It describes pelvic osteotomy surgery to close the abdominal wall and partially tighten the bladder neck, as well as nursing management focusing on limiting trauma, infection monitoring, immobilization, and wound care.

1. Bladder Exstrophy
DR. LINDA DEL VECCHIO GILBERT
(MATT GAVIN)

2. Trifecta of Bladder Exstrophy:
 Epispadias: Opening of urethra is above normal placement on the glans of the
penis.
 Bladder Exstrophy: Open, inside-out bladder with inner surface exposed and the
dorsal urethra on the lower abdominal wall.
 Cloacal Exstrophy: Extrophy of both bladder and large intestine through
abdominal wall defect.

3. Signs of Bladder Exstrophy
 Separation of Pelvic Bone
 Low set Umbilicus
 Anteriorly Displaced Anus
 Genitalia Defects
 Inguinal Hernia
 Constant urine seepage

4. Male/Female Differences
Male
 Epispadias
 Upward Curvature of Penis
 Undescended Testes
 Inguinal Hernia
 Hypospadias of penis (Cloacal)
Female
 Epispadias
 Bifid Clitoris
 Small Labia Minora
 Separated Labia (Cloacal)
 Absent Vagina (Cloacal)
 Bifid Uterus (Cloacal)
 Separation of Clitoris (Cloacal)

5. Pelvic Osteotomy
 Surgical Closure of Lower Section of Bladder:
 Aids in closing the abdominal wall/blader
 Partial tightening of the bladder neck
 Bilateral uteral-reimplantation to correct reflux.
 Often performed 48-72 hours after birth.
 Usually delayed for at most 2 months after birth.
 Sub urethral collagen injections may help bladder control.
 Mitrofanoff appendicecal stoma.

6. Nursing Management
 Limit Trauma to the Area
 Monitor for Infection
 Apply nonadherant film dressing.
 Immobilize for 2-4 weeks (Bryant’s Traction).
 Epidural/PCA pain management
 Wound Care
 Monitor Urine Output
 Psychosocial Assisstance

7. Fin