Bladder Exstrophy

Case Report
Ferdy Mayo, Guntur Surya Alam, Bintang Soetjahjo
Departement of surgery, Sebelas Maret University
and Dr Moewardi Hospital Surakarta
Introduction :
Bladder exstrophy is a complex congenital abnormality in genitourinary system, characterized
by the opening of the bladder at the lower abdominal wall. It is a rare case, with incidence of 1
per 10.0000 to 1 per 50.000 live births. That occurs less frequently in women than in men, with
a 2.3:1 as male & female ratio. Congenital defect that require reconstruction is a challenge for
the surgeon to close the defect and maintain function. Reconstruction technique should
provide the function of the genitourinary system and an aesthetic form.
Case Report :
Reported case of a 5 days baby with a bladder exstrophy and symphysiolysis. Operation has
been performed to reconstruction the bladder with Complete Primary Repair for Exstrophy
(CPRE) technique and the pubis symphysis is reapproximated using two figure-of-eight. Post
operation follow up revealed that showed good outcomes after undergoing surgical treatment.
Discussion
The timing of reconstruction defect of bladder exstrophy is in the neonatal period. We choose
CPRE in this case, which bladder neck, urethra and vagina as a unit moved posteriorly within
the pelvis. Its offer advantages, as it may maximize the opportunity for normal bladder
development and the potential for urinary continence. Pubis symphysis reapproximated using
two figure-of-eight. It is need for a regular long term follow up to evaluate the complication of
closure and consider for the other reconstruction
Conclusions
Has been reported case of a 5 days baby with a bladder exstrophy and symphysiolysis.
Operation has been performed to reconstruction the bladder with Complete Primary Repair for
Exstrophy (CPRE) technique and the pubis symphysis is reapproximated using two figure-of-
eight. Post operation follow up revealed that showed good outcomes after undergoing surgical
treatment.
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Fig. 1 : Bladder exstrophy in
female infant, with epispadial
urethra, bifid clitoris, the vagina
and anus appears to be displaced
anteriorly.
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Fig. 2 : X-ray showing wide
pubic diastasis
Fig. 5 : The rectus fascia can be closed
in the midline, adequate skin closure
and reaprroximate the bifid clitoris by
denuding them medially and made the
neourethra
Fig. 3 : Complete Primary Repair for Exstrophy (CPRE)
Fig. 4 : pubis symphysis is
reapproximated using two
figure-of-eight