Bladder exstrophy is a rare but serious congenital anomaly where the bladder is turned inside out and exposed outside the abdomen. It is part of a complex group of birth defects affecting the lower abdominal wall, bladder, urinary tract, and sometimes the genitalia and pelvis. Without treatment, it leads to continuous urine leakage, increased risk of infections, urinary incontinence, and potential kidney damage.
With timely diagnosis and expert pediatric urology surgery, children born with bladder exstrophy can regain continence, protect kidney function, and achieve a significantly improved quality of life. In Nagpur, Dr. Sadashiv Bhole provides advanced care for complex urological conditions like bladder exstrophy through a multidisciplinary and compassionate approach.
What is Bladder Exstrophy?
Bladder exstrophy occurs when the bladder and associated structures fail to close properly during fetal development. The inner surface of the bladder and urethra are exposed on the abdominal wall, and the pelvic bones are often widely separated.
This condition is part of the Bladder Exstrophy-Epispadias Complex (BEEC), which includes:
- Classic bladder exstrophy: Bladder exposed on the lower abdomen
- Epispadias: Urethra opens abnormally on the upper surface of the penis or clitoris
- Cloacal exstrophy: A severe form involving intestines and reproductive organs
Signs and Symptoms of Bladder Exstrophy
- Visible bladder plate on the lower abdomen—open, moist, red tissue
- Continuous leakage of urine from the exposed bladder
- Flattened, short penis or abnormal clitoris in females
- Widely spaced pubic bones and abnormal walking gait
- Abnormal external genitalia
- In older children:
- Urinary incontinence
- Recurrent urinary tract infections (UTIs)
- Bedwetting and voiding dysfunction
- Risk of hydronephrosis or child nephrolithiasis
Causes and Risk Factors
- Exact cause unknown, but likely genetic mutations or familial factors
- Abnormal development of the cloacal membrane during fetal growth
- Higher prevalence in males compared to females
- Rare environmental exposures during early pregnancy
Complications if Left Untreated
- Continuous urinary leakage and skin irritation or breakdown
- Repeated pediatric UTIs and ascending kidney infections
- Impaired kidney function due to vesicoureteral reflux or hydronephrosis
- Social difficulties and psychological impact due to incontinence
- Increased risk of bladder cancer later in adolescence or adulthood
Diagnosis of Bladder Exstrophy
Diagnosis is often obvious at birth due to visible abnormalities. Prenatal ultrasound may sometimes raise suspicion if the bladder is not seen filling normally.
Additional diagnostic evaluations include:
- Pelvic X-rays to assess pelvic bone structure
- Renal ultrasound to evaluate kidney anatomy and function
- MCUG (Micturating Cystourethrogram) after surgical repair to check for reflux
- MRI pelvis for complex cases
Surgical Treatment of Bladder Exstrophy
The primary goals of surgery are to close the bladder and abdominal wall, reconstruct the urinary tract and genitalia, restore urinary continence, preserve kidney function, and achieve good cosmetic and psychological outcomes.
Because of the complexity, bladder exstrophy is treated through staged surgeries over months or years:
- Initial Closure (within first 72 hours of life): Closes bladder, abdominal wall, and pelvic bones. May require osteotomy for bone alignment.
- Epispadias Repair: Reconstructs urethra and external genitalia, usually between 6–12 months of age.
- Bladder Neck Reconstruction (BNR): Performed later to restore continence and enable dry intervals.
- Augmentation Cystoplasty (if needed): Enlarges bladder capacity using bowel segments if bladder is too small.
- Continence Management Procedures: May include Mitrofanoff catheterizable stoma in cases of long-term voiding dysfunction or incontinence.
Recovery and Long-Term Care
- Regular follow-ups to monitor kidney function, continence, and bladder growth
- Close involvement of pediatric nephrology for kidney protection
- Behavioral therapy and parental counseling for emotional support
- Bladder training or intermittent catheterization as needed
- Psychosocial support to address social and emotional challenges
Consulting an Expert Pediatric Urologist in Nagpur
Bladder exstrophy, though complex and challenging, is treatable with a structured, multidisciplinary surgical approach. Early intervention by an experienced pediatric urologist like Dr. Sadashiv Bhole ensures the best possible outcomes—helping children achieve continence, healthy kidney function, and a better quality of life.
If your child is born with bladder exstrophy or related abnormalities, don’t delay seeking expert care to give them the future they deserve.
