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Approach to the Exstrophy Patient

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Transition and Lifelong Care in Congenital Urology

Part of the book series: Current Clinical Urology ((CCU))

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Abstract

Bladder exstrophy presents by prenatal ultrasound or at birth. It is a major birth defect that causes distortion of the lower abdominal wall and external genitalia. Exstrophy is thought to be on the spectrum of disease including epispadias, bladder exstrophy (both classic and variants), and cloacal exstrophy (EEC). Epispadias is the least severe form on the spectrum, presenting with a dorsally open urethra, mild pelvic diastasis, and a closed bladder. Classic bladder exstrophy (CBE) presents with a lower abdominal wall defect with an open bladder and a significant pubic diastasis. Cloacal exstrophy is the most severe end of the spectrum and presents with two bladder halves with the cecum in between. Cloacal exstrophy can present with other anomalies as well including gastrointestinal, central nervous system, and musculoskeletal.

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References

  1. Gearhart JP, Rink RC, Mouriquand PD. Pediatric urology. 2nd ed. Philadelphia: Elsevier; 2010.

    Google Scholar 

  2. Jarzebowski AC, et al. The Kelly Technique of bladder exstrophy repair: continence, cosmesis and pelvic organ prolapse outcomes. J Urol. 2009;182(4 Suppl):1802–6.

    Article  CAS  PubMed  Google Scholar 

  3. Berrettini A, Castagnetti M, Rigamonti W. Radical soft Tissue mobilization and reconstruction (Kelly procedure) for bladder exstrophy [correction of exstrophy] repair in males: initial experience with nine cases. Pediatr Surg Int. 2009;25(5):427–31.

    Article  PubMed  Google Scholar 

  4. Stec AA, Baradaran N, Schaeffer A, Geahart JP, Matthews RI. The modern staged repair of classic bladder exstrophy: a detailed postoperative management strategy for primary bladder closure. J Pediatr Urol. 2012;8(5):549–55.

    Article  PubMed  Google Scholar 

  5. Mushtaq I, Garriboli M, Smeulders N, Cherian A, Desai D, Eaton S, Duffy P, Cuckow P. Primary Bladder exstrophy closure in neonates: challenging the traditions. J Urol. 2014;191(1):193–8.

    Article  CAS  PubMed  Google Scholar 

  6. Baird AD, Sponseller PD, Gearhat JP. The place of pelvic osteotomy in the modern era of bladder exstrophy reconstruction. J Pediatr Urol. 2005;1:31.

    Article  CAS  PubMed  Google Scholar 

  7. Woodhouse CR, Ransley PG, Williams DI. The patient with exstrophy in adult life. Br J Urol. 1983;55(6):632–5.

    Article  CAS  PubMed  Google Scholar 

  8. Gargollo PC, Borer JG, Diamond DA, Hendren WH, Rosoklija I, Grant R, et al. Prospective followup in patients after complete primary repair of bladder exstrophy. J Urol. 2008;180:1665e70. discussion 70.

    Article  Google Scholar 

  9. Schaeffer AJ, Stec AA, Baradaran N, Gearhart JP, Mathews RI. Preservation of renal function in the modern staged repair of classic bladder exstrophy. J Pediatr Urol. 2013;9(2):166–73.

    Article  Google Scholar 

  10. Hale JM, Wood DN, Hoh IM, Neild GH, Bomanji JB, Chu A, Woodhouse CR. Stabilization of renal deterioration caused by bladder volume dependent obstruction. J Urol. 2009;182(4 Suppl):1973–7.

    Article  PubMed  Google Scholar 

  11. Austin JC. Long-term risks of bladder augmentation in pediatric patients. Curr Opin Urol. 2008;18:408.

    Article  PubMed  Google Scholar 

  12. Austen M, Kalble T. Secondary malignancies in different forms of urinary diversion using isolated gut. J Urol. 2004;172(3):831–8.

    Article  CAS  PubMed  Google Scholar 

  13. Husmann DA, Rathubun SR. Long-term follow up of enteric bladder augmentations: the risk of malignancy. J Pediatr Urol. 2008;4(5):381–5.

    Article  CAS  PubMed  Google Scholar 

  14. Smeulders N, Woodhouse C. Neoplasia in adult exstrophy patients. BJU Int. 2001;88:623–8.

    Article  Google Scholar 

  15. Higuchi TT, Fox JA, Husmann DA. Annual endoscopy and urine cytology for the surveillance of bladder tumors after enterocystoplasty for congenital bladder anomalies. J Urol. 2011;186(5):1791–5.

    Article  PubMed  Google Scholar 

  16. Chan DY, Jeffs RD, Gearhart JP. Determinants of continence in the bladder exstrophy population: predictors of success? Urology. 2001;57:774–7.

    Article  CAS  PubMed  Google Scholar 

  17. Ben-Chaim J, Docimo SG, Jeffs RD, Gearhart JP. Bladder exstrophy from childhood into adult life. J R Soc Med. 1996;89:39–46.

    Google Scholar 

  18. Baradaran N, Stec A, Wang MH, Cervellione RM, Luskin J, Gearhart JP. Urinary diversion in early childhood: indications and outcomes in exstrophy patients. Urology. 2012;80(1):191–5.

    Article  PubMed  Google Scholar 

  19. Massanyi EZ, et al. Bladder capacity as a predictor of voided continence after failed exstrophy closure. J Pediatr Urol. 2013;10:171–5.

    Article  PubMed  Google Scholar 

  20. Lloyd JC, Spano SM, Ross SS, Wiener JS, Routh JC. How dry is dry? A review of definitions of continence in the contemporary exstrophy/epispadias literature. J Urol. 2012;188(5):1900–4.

    Article  PubMed  Google Scholar 

  21. Baird AD, Nelson CP, Gearhart JP. Modern staged repair of bladder exstrophy: a contemporary series. J Pediatr Urol. 2007;3(4):311–5.

    Article  CAS  PubMed  Google Scholar 

  22. Shaw MB, Rink RC, Kaefer M, Cain MP, Cassie AJ. Continence and classic bladder exstrophy treated with staged repair. J Urol. 2004;172(4 pt 1):1450–3.

    Article  PubMed  Google Scholar 

  23. Gupta AD, Wood D, Woodhouse CJ. Bladder exstrophy: a 20 year follow up. Atlanta: American Urologic Association; 2012.

    Google Scholar 

  24. Salem HK, Eisa M. Long-term follow-up (18–35 years) of male patients with history of bladder exstrophy repair in childhood: erectile function and fertility potential outcome. J Sex Med. 2012;9(5):1466–72.

    Article  PubMed  Google Scholar 

  25. Ansari MS, Cervellione RM, Gearhart JP. Sexual function and fertility issues in cases of exstrophy epispadias complex. Indian J Urol. 2010;26(4):595–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Ben-Chaim J, Jeffs RD, Reiner WG, Gearhart JP. The outcome of patients with classic bladder exstrophy in adult life. J Urol. 1996;155(4):1251–2.

    Article  CAS  PubMed  Google Scholar 

  27. Anusionwu I, Tekes A, Stec AA, Gearhart JP, Wright EJ. Comparison of musculoskeletal anatomic relationships, determined by magnetic resonance imaging, in postpubertal female patients with and without classic bladder exstrophy. BJU Int. 2013;112(2):195–200.

    Article  Google Scholar 

  28. Nakhal RS, Deans R, Creighton SM, Wood D, Woodhouse CR. Genital prolapse in adult women with classical bladder exstrophy. Int Urogynecol J. 2012;23(9):1201–5.

    Article  PubMed  Google Scholar 

  29. Giron MA, Passerotti CC, Nguyen H, Cruz JA, Srougi M. Bladder exstrophy: reconstructed female patients achieving normal pregnancy and delivering normal babies. Int Braz J Urol. 2011;37(5):605–10.

    Article  PubMed  Google Scholar 

  30. Deans R, Banks F, Liao LM, Wood D, Woodhouse C, Creighton SM. Reproductive outcomes in women with classic Bladder exstrophy: an observational cross-sectional study. Am J Obstet Gynecol. 2012;206(6):496.

    Article  PubMed  Google Scholar 

  31. Anderson DL, Murray CD, Hurell R. Experiences of intimacy among people with bladder exstrophy. Qual Health Res. 2013;23(12):1600–12.

    Article  PubMed  Google Scholar 

  32. Pennison MC, Mednick L, Grant R, Price D, Rosokija I, Huang L, Ziniel S, Borer JG. A survey to assess body and self-image in individuals with bladder exstrophy: a call for psychosocial support. J Urol. 2013;190(4 Suppl):1572–6.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Miami Children’s Hospital, Miami, FL, USA

    Angela D. Gupta M.D.

  2. Department of Pediatric Urology, The Johns Hopkins Hospital, Baltimore, MD, USA

    John P. Gearhart M.D., F.A.A.P., F.A.C.S., F.A.C.S. (Ed.) (Hon.)

Authors
  1. Angela D. Gupta M.D.
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  2. John P. Gearhart M.D., F.A.A.P., F.A.C.S., F.A.C.S. (Ed.) (Hon.)
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Corresponding author

Correspondence to Angela D. Gupta M.D. .

Editor information

Editors and Affiliations

  1. Center for Genitourinary Reconstruction, Glickman Urological and Kidney Institute, Cleveland, Ohio, USA

    Hadley M. Wood

  2. Adolescent and Reconstructive Urology, University College London Hospitals, London, United Kingdom

    Dan Wood

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© 2015 Springer International Publishing Switzerland

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Gupta, A.D., Gearhart, J.P. (2015). Approach to the Exstrophy Patient. In: Wood, H., Wood, D. (eds) Transition and Lifelong Care in Congenital Urology. Current Clinical Urology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-14042-1_3

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  • DOI: https://doi.org/10.1007/978-3-319-14042-1_3

  • Publisher Name: Humana Press, Cham

  • Print ISBN: 978-3-319-14041-4

  • Online ISBN: 978-3-319-14042-1

  • eBook Packages: MedicineMedicine (R0)

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