Bladder exstrophy

Diagnosis  

Bladder exstrophy, a condition that can be incidentally detected during routine pregnancy ultrasounds, can be more definitively diagnosed prenatally through ultrasound or magnetic resonance imaging (MRI) scans. The diagnostic signs include issues with bladder filling and emptying, a low placement of the umbilical cord on the abdomen, separation of the pubic bones forming the pelvis, and underdeveloped genitalia. 

At times, the condition might not be noticeable until after the baby’s birth. In newborns, medical professionals examine for the following: 

• The size of the exposed portion of the bladder 
• Testicle positioning 
• Bulging of the intestine through the abdominal wall (inguinal hernia) 
• The structure around the navel 
• The location of the rectal opening (anus) 
• The degree of separation between pubic bones and the ease of pelvic movement. 

Treatment  

After delivery, a clear plastic dressing is applied to protect the exposed bladder. Newborns with bladder exstrophy undergo reconstructive surgery post–birth, with the goal of achieving several objectives: ensuring adequate urine storage space, developing external genitalia that are both aesthetically pleasing and functional, attaining bladder control (continence), and preserving kidney function. 

The two types of surgical repair include: 

• Complete Repair: This is a one–time surgery that fixes everything at once. The doctor closes the bladder, abdomen, and fixes the urethra and outer genitalia. They can do this right after the baby is born or when the baby is a few months old. Sometimes they also fix the bones in the pelvis, but if the baby is very young and the bones are flexible, they might wait.
• Staged Repair: This method involves three surgeries at different times. The first is done in the first few days after birth to close the bladder and abdomen. The second happens when the baby is 6 to 12 months old and fixes the urethra and private parts. The last surgery, when the child is around 4 to 5 years old, helps with bladder control.