Definition

Bladder exstrophy repair is surgery to repair a birth defect in which the bladder is inside out and sticks out of the abdominal wall. The pelvic bones are also separated.

Alternative Names

Bladder birth defect repair; Everted bladder repair; Exposed bladder repair; Repair of bladder exstrophy

Description

Bladder exstrophy repair involves two surgeries: One to repair the bladder and another to attach the pelvic bones to each other.

The first surgery separates the exposed bladder from the abdomen wall and closes the bladder. The bladder neck and urethra are repaired. A flexible, hollow tube called a catheter is placed to drain urine from the bladder through the abdominal wall. A second catheter is left in the urethra to promote healing.

The second surgery, pelvic bone surgery, may be done along with the bladder repair. Or, it may be delayed for weeks or months.

Indications

The surgery is recommended for children who are born with bladder exstrophy. Bladder exstrophy occurs more often in boys and is often associated with other birth defects.

Surgery to repair the defect is usually performed within the first 48 hours after birth.

Risks

Risks with this procedure may include:

• Chronic urinary tract infections
• Erectile/sexual dysfunction
• Inadequate urinary control (incontinence)
• Need for future surgeries

Risks for any anesthesia are:

• Breathing problems
• Reactions to medications

Risks for any surgery are:

• Bleeding
• Infection

Expectations after surgery

Surgery is necessary to:

• Allow the child to develop normal urinary control
• Avoid future problems with sexual function
• Improve the child's physical appearance
• Prevent infection that could decrease kidney function

Some children are unable to develop enough urinary control and may need surgery again later.

Convalescence

After pelvic bone surgery, the child will need to be in a lower body cast or sling. This helps the bones heal.

How long the child stays in the hospital depends on:

• The severity of the bladder defect
• The number of surgeries needed
• Whether other medical problems exist

References

Gearhart JP, Mathews R. Exstrophy-Epispadias Complex. In: Wein AJ. Wein: Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 119.