Bladder exstrophy is a congenital (present at birth) abnormality of the bladder. It happens when the skin over the lower abdominal wall (bottom part of the tummy) does not form properly, so the bladder is open and exposed on the outside of the abdomen. In epispadias, the urethra does not form properly.

1. EXSTROPHY OF
BLADDER
PRESENTED BY:
SHARMITAGAYEN
GNM2ND YEAR
SNUNURSINGINSTITUTE

2. INTRODUCTION:
Exstrophy of bladder usually associated
with numbers of congenital anomalies,
related to urogenital tract, Musculo-
skeletal system and sometimes of GI
system.
Male children are more commonly
affected.

3. Contd.
 It is also termed as ‘ectopic vesicae’ i.e. malposition or
displacement of urinary bladder from its normal position
in the pelvis.
 Exstrophy of bladder is a congenital malformation in
which the lower portion of the abdominal wall and the
anterior wall of the bladder are missing, so that the
bladder is everted through the opening and may found on
the lower abdomen just above the symphysis pubis, with
continuous passage of urine to the outside.

4. DEFINITION:
• Exstrophy means ‘turned inside out’. Bladder exstrophy is a
congenital (present at birth) abnormality of the bladder. It
happens when the skin over the lower abdominal wall
(bottom part of the tummy) does not form properly, so the
bladder is open and exposed on the outside of the
abdomen.

5. INCIDENCE:
•The birth prevalence of classic bladder exstrophy has
been estimated to be between 1 in 10,000 and 1 in
50,000 livebirths. Males are affected 2-3 times more
often than females.

6. RELATED ANATOMY:

10. ETIOLOGY:
•Idiopathic
•Due to any birth defect
•Genetic factors
•Environmental factors

11. CLINICAL MANIFESTATIONS:
• Exposed bladder from the abdomen
• Flattened puborectal sling
• Pubis symphysis separated
• Ulcer in the bladder mucosa
• Dribbling of urine
• Skin excoriation

12. PATHOPHYSIOLOGY:
Due to an unknown etiology/birth defect
Cloacal membrane bursts
Abdominal muscle not formed fully
Urorectal septum separate the bladder from bowel and intestine
The bladder from the inside pokes outside the belly
Exstrophy of bladder

13. DIAGNOSIS
• Cystoscopic examination
• X-Ray
• USG
• IVP
• Urodynamic testing

14. MEDICAL MANAGEMENT
•Antibiotic 3rd gen: ceftriaxone

15. SURGICAL MANAGEMENT
• MSRE – Modern Staged Repair of
Exstrophy
• CPRE – Complete Primary Repair of
Exstrophy

16. Supportive Nursing care
Preoperative period:
• Protection of bladder area from infections and trauma.
• Avoid irritating clothing and linen over the exposed bladder
• Positioning the infant and back or side
• Humidifying the exposed bladder by covering with wet gauze
• Maintaining aseptic precautions and general hygiene measures along with other
routine care.
• Preparation of parents and child for planned reconstructive surgery

17. Postoperative period:
• Close monitoring of child condition, vitals signs, features of infection
• Maintaining intake output.
• Care of urinary catheter
• Maintaining urinary catheter position, drainage
• Maintain aseptic precaution during procedure.
• Instruct mother for necessary precautions related to urinary catheter
dislodgement or leakage, prevention of infections.
• Necessary information and demonstration to parents regarding home –based
care

18. NURSING DIAGNOSIS:
DAY-1 : PRE OPERATIVE DAY
• Impaired body image related to exstrophy of bladder as
evidenced by baby’s mother’s verbalization.
• Fluid volume deficit related to constant urine dribbling as
evidenced by dry skin.
• Risk for infection related to exposed bladder.

19. DAY-2 : OPERATIVE DAY
• Interrupted family process related to chronic illness and surgery
as evidenced by patient’s mother’s verbalization.
• Impaired nutrition less than body requirement related to NPM as
evidenced by mother’s verbalization.
• Incomplete preoperative preparation related to unable to
maintain by mother secondary to stress for operation as
evidenced by poor hygiene

20. POST OPERATIVE DAY 1
• Pain related to surgical incision as evidenced by irritable cry,
mother’s verbalization and unable to take breastmilk.
• Respiratory distress related to pain as evidenced by respiratory
rate 50 b/m.
• High risk for bleeding from the surgical site related to surgery in
bladder.
• High risk for impaired fluid balance related to surgery in bladder.

21. POST OPERATIVE DAY 2
•Risk for infection related to surgical incision.

22. COMPLICATIONS:
Incontinence of urine
Infection
Dehydration
Progressive weight loss
Even with successful surgery, people may have long-term
complications. Some of the most common include:
• Vesico-ureteral reflux
• Bladder spasm
• Bladder calculus
• Urinary tract infections

23. HEALTHEDUCATION:
• To keep the bladder area clean and dry.
• Covering the bladder with sterile petroleum gauze to prevent infection and
ulceration of mucosa.
• Preventing diaper from adhering to the area.
• Frequently changing the diaper for comfort and to prevent constant bad odour of
urine.

24. PROGNOSIS:
• After reconstructive surgery of the bladder, continence rates of about 80%
are expected during childhood. Though spontaneous voiding is the main
issue, additional surgery might be needed to optimize bladder storage and
emptying function. In cases of definite reconstruction failure, urinary
diversion should be undertaken. In puberty, genital and reproductive
function constitute increasingly important issues for both sexes.
Psychosocial and psychosexual outcome reflect the importance of long-
term care (from birth into adulthood) from a multidisciplinary team of
experts for parents and children which facilitate an adequate quality of life.

25. DAY TO DAY PROGRESS:
21.05.2021 22.05.2021 23.05.2021 24.05.2021
Temperature(in farenheight)
Pulse
Repiration
Weight
Blood pressure
97.6
128 b/m
40 b/m
2.75 kg
64/41 mm hg
97.7
128 b/m
42 b/m
2.75 kg
60/40 mm hg
98.1
130 b/m
40 b/m
2.75 kg
65/42 mm hg
97.6
125 b/m
40 b/m
2.75 kg
64/41 mm hg
Total intake
Total output
220 ml/24hr
(along with
breastmilk)
178 ml/24 hr
170 ml /24 hr
130 ml /24 hr
250 ml/24 hr
(along with
medicine)
200 ml/24 hr
Breastfeeding
started.

26. SUMMARIZATION:
• Introduction
• Definition
• Incidence
• Related anatomy and physiology
• Etiology
• Pathophysiology
• Clinical manifestations
• Diagnosis
• Management (medical,surgical, nursing)
• Nursing diagnosis and care plan
• Complication
• prognosis

27. CONCLUSION:
• A carefully planned surgical reconstruction for bladder
exstrophy can lead to satisfactory long-term urinary
continence in most patients. Factors contributing to
successful results include early bladder closure, pelvic
osteotomy, adequate bladder neck reconstruction with
bladder neck suspension in girls, and a motivated child and
family. Ultimate predictors of outcome in bladder exstrophy
repair are difficult to ascertain.