Bladder exstrophy is a rare congenital defect where the bladder is open and exposed outside the abdomen, occurring in approximately 1 in 50,000 live births and affecting males more frequently than females. Diagnosis can be established through fetal ultrasound and other imaging techniques, while surgical management options include staged repairs or complete primary repair methods. Nursing management involves monitoring for infection, wound care, and psychosocial support.

1. URINARY BLADDER
EXSTROPHY/EXSTROPHY OF BLADDER
PRESENTED BY:
M.C.KNIRANDA
ASSISTANT PROFESSOR
SSNSR, SU.

2. INTRODUCTION
• It is also termed as ‘Ectopic vesicae’
• Exstrophy means ‘turned inside out’.
• Bladder exstrophy is a congenital abnormality of
the bladder.
•Associated with numbers of congenital anomalies,
related to Urogenital tract, Musculo- skeletal
system and sometimes of GI system.

3. DEFINITION
•Exstrophy of bladder is a congenital malformation in which lower
portion of the abdominal wall does not form properly and the
anterior wall of the bladder is missing, so the bladder is open and
exposed on the outside of the abdomen.

4. INCIDENCE
•1 in every 50,000 live births.
•It is rare congenital abnormality.
• Males are affected 2-3 times more often than females.

5. In boys born with bladder
exstrophy, the bladder is on the
outside of the body and the
penis and urethra are not fully
closed

6. In girls born with bladder
exstrophy, the bladder is on the
outside of the body and the
vagina is not fully formed

7. ETIOLOGY
• Idiopathic
• Due to any birth defect
•Use of assisted reproduction
• Family history
• Environmental factors

9. DIAGNOSIS
• Fetal Ultrasound
• Cystoscopic examination (a surgical procedure that allows a healthcare
provider to examine the urinary tract, including the bladder, urethra, and
ureters, to help identify problems)
• X-Ray
• USG IVP
• Urodynamic testing (any procedure that looks at how well parts of the lower
urinary tract)
• Clinically obvious at birth

10. SURGICAL MANAGEMENT
1. MSRE – (Modern Staged Repair of Exstrophy)
Staged repair involves three operations.
•First procedure closes the bladder and the abdomen
- within 72 hours after birth
•Second procedure, repairs the urethra and sex organs.
- age 6 to 12 months
•Third procedure, when the child is old enough to participate in toilet training,
surgeons perform bladder neck reconstruction
- 4 to 5 years.

11. SURGICAL MANAGEMENT
2. CPRE – Complete Primary Repair of Exstrophy
Complete repair surgery is performed in a single procedure
that closes the bladder and the abdomen and repairs the
urethra and outer sex organs.
This can be done soon after birth, or when the baby is
around two to three months old.

12. NURSING MANAGEMENT
Limit trauma to the surgical site
Monitor for infection
Apply non adherent film dressing
Wound care
Monitor urine output
Psycosocial assistance

13. THANK YOU