Exstrophy of the Bladder and Epispadias
What is exstrophy of the bladder?
Exstrophy of the bladder is a complex combination of disorders that occurs during
fetal development. The disorder usually involves many systems in the body, including
the urinary tract, skeletal muscles and bones, and the digestive system. Bladder exstrophy
means that the bladder is essentially inside out and exposed on the outside of the
abdomen. Because the bladder and other structures are exposed to the outside of the
body, urine constantly trickles onto the skin causing local irritation.
What is epispadias?
Epispadias is usually seen with exstrophy of the bladder. Epispadias occurs when the
urethral opening, which is the hollow tube that drains urine from the bladder to the
outside of the body, is in an abnormal location. In males, the opening is usually
on the topside of the penis and not the tip. This is different than hypospadias where
the opening is usually underneath the penis. In girls, the urethral opening may be
positioned further up the urethra and may be bigger and longer than normal. Often
in girls, the opening extends to the bladder.
Who is affected by exstrophy of the bladder?
According to the American Urologic Association, this is a rare disorder that occurs
in about 2.07 in every 100,000 births. It is slightly more common in males and varies
in severity. The cause of exstrophy of the bladder is unknown. Although some reports
show a clustering of exstrophy of the bladder in families, suggesting an inherited
factor. However, the chance for parents to have another child with exstrophy of the
bladder is small (1% or less). The disorder may occur in varying degrees from mild
to severe. In many cases, exstrophy of the bladder is associated with the following:
Widened pubic bones
Outwardly rotated legs and feet
Triangle-shaped defect in the abdomen and visibility of the membrane of the bladder that
is usually bright pink
Abnormally-shaped abdominal muscles
Displacement of the umbilicus (belly button), usually above the defect
Umbilical hernia may be present (section of intestine protrudes through a weakness
in the abdominal muscles)
Short, small penis with urethral opening along top of penis (epispadias)
Narrow vaginal opening, wide labia, and short urethra
How is exstrophy of the bladder diagnosed?
Exstrophy of the bladder can usually be diagnosed by fetal ultrasound before an infant
is born. After the infant is born, exstrophy can be determined by physical exam. Your
child's doctor may order other tests.
What is the treatment for exstrophy of the bladder?
Your baby’s health care provider will figure out the best treatment for based on:
How old your baby is
His or her overall health and medical history
How sick he or she is
How well your baby can handle specific medications, procedures, or therapies
How long the condition is expected to last
Your opinion or preference
After a diagnosis is made, your child will be referred to a surgeon for surgical repair.
There are usually three stages to the surgical repair that start when your child is
as young as 48 hours old. The first stage involves internalization of the bladder
and closing the abdomen. The second stage may be done as early as 6 months of age and
involves repairing the epispadias and other genital abnormalities. The final surgery
is done at around age 4 to 5, when the bladder is large enough and the child is psychologically
ready to be dry. This final surgery involves reconstruction of the urinary tract including
the bladder, and other structures of the urinary tract.