Bladder exstrophy

Case contributed by Dr Iqbal Naseem

Presentation

History of abnormal gait, continuous dribbling of urine, deficient lower abdominal muscles and ambiguous genitalia.

Patient Data

Age: 2 years
Gender: Male

Intravenous pyelogram

Modality: Fluoroscopy

Serial IVP films showing:

Widely separated pubic bones with absent symphysis pubis.

There is no identifiable shape of urinary bladder due to lack of anterior bladder wall.

Ureters are laterally and upward angulated at the ureterovesical junctions.

Extravasation of contrast is seen extending from urinary bladder to the exterior.

Case Discussion

Bladder exstrophy or "ectopia vesicae" is characterized by a deficient lower anterior abdominal wall along with the anterior walls of urinary bladder. There may be a rudimentary posterior wall of the urinary bladder.

Associated bony findings include widely separated pubic bones with absent symphysis pubis, leading to characteristic "waddling gait".

Surgical repair is treatment of choice to close defect and to improve patients quality of life by preventing dribbling of urine, repeated urinary tract infections leading to renal failure and in long-standing cases to prevent malignant transformation due to repeated irritation.

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Case Information

rID: 20089
Case created: 2nd Nov 2012
Last edited: 7th Oct 2015
Inclusion in quiz mode: Included

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