Bladder exstrophy

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Congenital malformation of the genitourinary system, in which there is no anterior abdominal wall and the anterior wall of the bladder, there is a splitting of the urethra and pelvic bones discrepancy of up to 7 centimeters - is bladder exstrophy.

Manifestation of disease

The protrusion of the mucous membrane of the rear wall of the bladder is determined in the suprapubic region, which has a bright red color. When boys suffer from bladder exstrophy from the mouths of the ureters constantly, urine excreted. The skin is gradually scaring in this area, their maceration occurs due to the constant contact with urine. The umbilicus is most often absent. The penis is reduced in size, is most often split.

In girls, the urethra is also split, the clitoris is divided into two parts, and the labia may be presented in two halves. The vagina is covered with a mucous membrane of the bladder and urethra. In addition, there is a discrepancy in the pelvis symphysis pubis to 7 centimeters, which leads to disruption of gait. Continual contacting mucosa of the bladder with the surrounding tissues and the external environment causes the development of pyelonephritis, cystitis and kidney, followed by shrinkage.

Apart from exstrophy these children can suffer from cryptorchidism, inguinal hernias, and various malformations of ureters, kidneys, possibly with fecal incontinence. The girls have malformations of reproductive system - a doubling of the vagina, two-horned uterus.

Children almost deprived of the opportunity to communicate normally and play with their peers, they are constantly felt the smell of urine.


Treatment of bladder exstrophy

Bladder exstrophy is subjected only to surgical treatment. Correction of the defect should be performed in the early stages of life. All kinds of operations are made from birth up to 1-2 years, when there come the change of scar tissue around the bladder. The volume of surgical intervention depends on the size of exstrophy, the general condition of the child, his or her sex.

Surgical treatment of this defect consists of several stages:

  • Plastics of the anterior abdominal wall and the front of the bladder;
  • Correction of urethra splitting and plastics of the penis;
  • Еlimination of urinary incontinence with a possible augmentation of the bladder.

Primary plastics of the bladder is made in the first two weeks of life. During this operation, there is a formation of the bladder using local fabrics. Next, the elimination of divergences of pubic bone with the strengthening of pelvic organ ligament apparatus.  anterior abdominal wall is Formed as well as the channel of urine through the urethra. The girls are subjected to plastics external opening of the urethra with the plasticity of the large and small labia.

At the age of 1-2 years, old boys are subjected to plastic surgery to eliminate epispadias.

Between 5-7 years the external sphincter of the urethra and bladder neck are modeled, because these structures play the most important role in the retention of urine. In the absence of growth of the bladder and its small size, augmentation is made to - increase its volume by its formation from the small intestine.



Why Belarus?

In the leading children's surgical center in Belarus, the professionals help children with bladder exstrophy. The experience and the use of modern equipment that meets the requirements of international standards ensure a positive outcome of the treatment of the defect and help the child to feel full.