Cookies help us deliver our services. By using our services, you agree to our use of cookies. Learn more

Bladder Exstrophy

What is Bladder Exstrophy ?

Bladder exstrophy is a rare congenital condition (present from birth) in which the bladder and parts of the urinary tract develop abnormally. In the developing fetus, the bladder may develop a flattened shape rather than a more round shape. Additionally in infants with bladder exstrophy, as the stomach abdominal wall and bladder are forming, the abdominal wall does not fully form. The bladder forms with exposure to the abdominal wall but also exposed to the external skin surface, essentially forming outside of the body. This malformation prevents the bladder from storing urine properly, leading to urinary incontinence and an increased risk of infections. Bladder exstrophy is part of the exstrophy-epispadias complex (EEC), a spectrum of congenital anomalies affecting the lower urinary tract, genitalia, and pelvis. It often requires multiple surgical procedures immediately after birth to reconstruct the bladder and restore function.

 

 

 

Synonyms

  • Exstrophic bladder
  • Ectopia vesicae

Bladder exstrophy is a rare congenital condition (present from birth) in which the bladder and parts of the urinary tract develop abnormally. In the developing fetus, the bladder may develop a flattened shape rather than a more round shape. Additionally in infants with bladder exstrophy, as the stomach abdominal wall and bladder are forming, the abdominal wall does not fully form. The bladder forms with exposure to the abdominal wall but also exposed to the external skin surface, essentially forming outside of the body. This malformation prevents the bladder from storing urine properly, leading to urinary incontinence and an increased risk of infections. Bladder exstrophy is part of the exstrophy-epispadias complex (EEC), a spectrum of congenital anomalies affecting the lower urinary tract, genitalia, and pelvis. It often requires multiple surgical procedures immediately after birth to reconstruct the bladder and restore function.

 

 

Acknowledgement of Bladder Exstrophy has not been added yet.

Bladder exstrophy occurs in approximately 1 in 30,000 to 50,000 live births and is more common in males than females, with a male-to-female ratio of about 3:1. It is more frequently seen in certain populations with a history of the condition in their families, suggesting a genetic component. It is more common in children of Caucasian families. There are also ties between fertility treatments such as IVF and increased risk of bladder exstrophy, but research is still ongoing.

 

Name Abbreviation
Exstrophic bladder
Ectopia vesicae

The exact cause of bladder exstrophy is not fully understood, but it is believed to result from abnormal embryonic development during early pregnancy. A failure of the lower abdominal wall and bladder to close properly during fetal development leads to the bladder being exposed outside the body. The region connecting the abdominal, reproductive, and urinary regions of the body’s organs is called the cloaca. Abnormal formation of one of the aspects of this region can affect all connecting organs. Genetic and environmental factors are thought to contribute to the condition, though no single gene mutation has been identified as the definitive cause.

 

Bladder exstrophy is present at birth and is characterized by:

  • Exposed bladder: The bladder is visible outside the abdominal wall and does not function properly.

  • Urine leakage: Because the bladder cannot store urine, continuous urine leakage occurs.

  • Widened pubic bones: The pelvic bones are abnormally positioned, leading to gait and posture abnormalities.

  • Epispadias: The urethra is improperly formed, often opening on the upper side of the penis in males and affecting the vaginal opening in females.

  • Undeveloped bladder and sphincter muscles: Leading to urinary incontinence.

  • Recurrent urinary tract infections (UTIs): Due to improper urinary storage and drainage.

  • Abnormal genital development: In females, the clitoris may be split, while in males, the penis may be small and curved (chordee).

Following surgical treatment at birth, children who have bladder exstrophy may continue to have symptoms from other bladder complications such as kidney infections or kidney stones, and in some cases increased risk of developing bladder cancer.

 

Bladder exstrophy is typically diagnosed at birth due to the visible abnormality of the bladder being outside the body. In some cases, it can be detected prenatally through imaging studies, particularly in the second or third trimester.

 

  • Prenatal Ultrasound: May show abnormalities in the lower abdominal wall and absence of a visible bladder.

  • MRI or Fetal MRI: Can provide more detailed imaging of the fetal anatomy before birth.

  • Postnatal Physical Examination: The diagnosis is usually confirmed immediately after birth based on the characteristic appearance.

  • X-rays and CT Scans: To assess pelvic bone structure and any associated skeletal abnormalities.

  • Voiding Cystourethrogram (VCUG): Performed after initial surgical repair to evaluate bladder function.

Treatment for bladder exstrophy requires complex surgical intervention, often in multiple stages, to reconstruct the bladder, restore continence, and improve cosmetic and functional outcomes. Treatment options include:

  • Primary Closure Surgery: Performed within the first 72 hours of life to place the bladder back inside the body and close the abdominal wall.

  • Staged Reconstruction: A series of surgeries performed over several years to improve bladder function, address urinary incontinence, and reconstruct the genitalia.

  • Bladder Augmentation: In cases where the bladder remains too small, parts of the intestine may be used to expand it.

  • Urinary Diversion (if needed): In severe cases, a surgical diversion may be performed to allow urine to drain into a collection bag.

  • Pelvic Osteotomy: Surgical correction of the pelvis to improve bladder support.

The prognosis for individuals with bladder exstrophy depends on the severity of the condition and the success of surgical interventions. With modern surgical techniques, many patients achieve good cosmetic and functional outcomes, including urinary continence. However, lifelong medical follow-up is often necessary to monitor for complications such as bladder dysfunction, recurrent UTIs, and, in some cases, infertility. With appropriate treatment, most individuals can lead healthy and active lives.

 

Tips or Suggestions of Bladder Exstrophy has not been added yet.
Choosing an exstrophy doctor Created by kskelly
Last updated 9 Nov 2014, 08:02 AM

Posted by aknuckey
9 Nov 2014, 08:02 AM

My daughter was just diagnosed with epispadias at 21 months. Would you be willing to discuss your experience over email or the phone? If so, please email me at aknuckey20@gmail.com, and we can then exchange phone numbers through email if you are willing.

Posted by kskelly
15 Dec 2008, 12:11 AM

Hello, I have to write regarding our son's experience and how choosing the wrong doctor has led to 4 additional surgeries (and we haven't even reached bladder neck) and unimagineable stress for our 4-year old. When our son was born in October, 2004, we were shocked and unprepared to find that he had a birth defect of any kind, much less one in such an important area. As a parent of a child with the same issue, you can relate to what I am saying. The issue was greatly downplayed by the hospital and we had no idea of the severity of the issue. The diagnosis given to us was 'epispadias' and we immediately began researching the condition and the doctor we were referred to (removed by moderator) is well-published on epispadias and came highly recommended by everyone at the hospital. We felt that we were in good hands and never thought to question how many epispadias surgeries he had previously performed. He used the 'Mitchell technique', taking our son from an epispadias to a hypospadias, and then performing a second surgery to take him from hypospadias to 'normal'. However, the surgery failed and he returned to hypospadias. (Most likely because he was sent home within an hour of waking up without any restrictions, but we also found out later that his urethra was blocked halfway so it may have been from that.) When we returned for our follow-up and showed (removed by moderator) that he was still urinating from the base of his penis, he said "No big deal, we'll just put a piece of skin there when we do his bladder". I'm not a doctor, but this didn't make much sense to me. If the urine ran through a tube and wasn't going all the way through, how was slapping a piece of skin there going to make it do so?? From birth we were told that my son's bladder would be fixed between 4-5 years old, when he absolutely, positively had an interest in potty training. Suddenly, just shy of 3 years old, a cysto was performed and they wanted to operate within 3 weeks and said 'we may not be able to fix it'. Words we had never heard before. Also, by some miracle, my son's bladder was on the inside so we had heard of bladder exstrophy while researching epispadias, it had never been used in his diagnosis. The 3-weeks didn't make much sense to me either since he had zero interest in potty training. If he absolutely had to have an interest in potty-training to do the surgery when it was the size they were hoping for, wouldn't it be even more important for him to be interested when it was extremely small, not less important? Due to the inconsistent information, we began to question (removed by moderator) on exactly how many of these bladder surgeries he had performed and what his success rate was. He would not give us a straight answer and started spouting of 'worldwide success rates'. After questioning him on his personal experience 3 times without a straight answer, we returned to the internet in search of another physician. This led us to Dr. John Gearhart at Johns Hopkins in Baltimore, MD. Four surgeries later (to fix the mess created), we are so grateful to have found him. Regardless of where you live, this is the surgeon you want to perform any exstrophy/epispadias surgeries on your child. (Oh yes, imagine our surprise to find out that our son had bladder exstrophy when we had been visiting doctors for over 3 years.) During our 18 months at Hopkins, we have met multiple families with children that have exstrophy/epispadias complex. The ones who are fortunate enough to have begun this journey with Dr. Gearhart have had minimal surgeries and huge success rates. The ones we have met that began their journey with other doctors, with greatly reduced exposure to this, have experienced less success, more surgeries and more complications. Please do not trust your child to anyone other than the urological department at Johns Hopkins. While we cannot turn back time and erase the start of our sons life, we can certainly rest easier knowing that he is now in the best hands and his a much higher chance of continence. Also, at Hopkins, they offer a clinic to work with your child to achieve a successful outcome (not available in smaller hospitals) as well as an annual Exstrophy picnic to put you and your child in touch with others dealing with the same experience. There is no distance too great to travel for the expertise you will receive at JHH.

Community Resources
Title Description Date Link
Association for the Bladder Exstrophy Community

The ABC is an international support network of individuals with bladder exstrophy (includes classic exstrophy, cloacal exstrophy, and epispadias), local parent-exstrophy support groups, and health care providers working with patients and families living with bladder exstrophy.

03/20/2017

Clinical Trials


Cords registry

CoRDS, or the Coordination of Rare Diseases at Sanford, is based at Sanford Research in Sioux Falls, South Dakota. It provides researchers with a centralized, international patient registry for all rare diseases. This program allows patients and researchers to connect as easily as possible to help advance treatments and cures for rare diseases. The CoRDS team works with patient advocacy groups, individuals and researchers to help in the advancement of research in over 7,000 rare diseases. The registry is free for patients to enroll and researchers to access.

Enrolling is easy.

  1. Complete the screening form.
  2. Review the informed consent.
  3. Answer the permission and data sharing questions.

After these steps, the enrollment process is complete. All other questions are voluntary. However, these questions are important to patients and their families to create awareness as well as to researchers to study rare diseases. This is why we ask our participants to update their information annually or anytime changes to their information occur.

Researchers can contact CoRDS to determine if the registry contains participants with the rare disease they are researching. If the researcher determines there is a sufficient number of participants or data on the rare disease of interest within the registry, the researcher can apply for access. Upon approval from the CoRDS Scientific Advisory Board, CoRDS staff will reach out to participants on behalf of the researcher. It is then up to the participant to determine if they would like to join the study.

Visit sanfordresearch.org/CoRDS to enroll.

Community Leaders

 

Expert Questions

Ask a question

Community User List

My daughter was diagnosed with female epispadias.
Volunteering for orphans
Hi My Name is Matthew Wrigley And i live in Australia and i was born with bladder exstrophy
I was born with bladder exstrophy--underwent 3 major & 2 minor corrective surgeries between ages 18 m/o through 8 y/o. At age 52 I was diagnosed with Henoch-Schonlein Purpera w/residual nephritis....
the mother of a 4 year old boy born with bladder exstrophy
Mom of 2 with a 4-year old son with exstrophy-epispadias complex.
I am a mother of two children. My eldest is 2 and the youngest is 6 months. My youngest, Jessica, was born 3 months early with Bladder Exstrophy and is currently in Great Ormond Street Hospital.

Start a Community


Don't See Your Condition On Rareshare?

Start your own! With a worldwide network of 8,000 users, you won't be the only member of your community for long.

FAQ


Have questions about rareshare?

Visit our Frequently Asked Questions page to find the answers to some of the most commonly asked questions.

Discussion Forum

Choosing an exstrophy doctor

Created by kskelly | Last updated 9 Nov 2014, 08:02 AM


Communities

Our Communities

Join Rareshare to meet other people that have been touched by rare diseases. Learn, engage, and grow with our communities.

FIND YOUR COMMUNITY
Physicians

Our Resources

Our rare disease resources include e-books and podcasts

VIEW OUR EBOOKS

LISTEN TO OUR PODCASTS

VIEW OUR GUIDES

Leaders

Our Community Leaders

Community leaders are active users that have been touched by the rare disease that they are a part of. Not only are they there to help facilitate conversations and provide new information that is relevant for the group, but they are there for you and to let you know you have a support system on Rareshare.