Bladder exstrophy repair is a surgical method of repairing a birth defect in which the bladder grows outside the abdominal wall. In infants who have this condition, the bladder, and sometimes other organs, are on the outer surface of the body. Other names for the procedure are:
- bladder birth defect repair
- everted bladder repair
- repair of bladder exstrophy
- exposed bladder repair
Bladder exstrophy is a birth defect. The abdominal wall and organs do not form correctly during fetal development. This causes the bladder to stick out of the abdomen. The pubic bones also separate.
The condition varies in severity. It is seen more often in boys than girls. According to Boston Children’s Hospital, it affects approximately 1 in 40,000 infants.
Bladder exstrophy is also associated with a number of other defects. These include:
- muscles that are weakened and misshapen in the lower abdominal wall
- widening of the pubic bones
- displaced belly button
- short urethra, wide-spread labia, and narrow vaginal opening (girls)
- shortened penis (boys)
- legs and feet that are rotated outward
Bladder exstrophy happens early in fetal development. The cause is not known.
Bladder exstrophy repair is used to move exposed abdominal organs, such as the bladder, back into the abdomen.
This is necessary for:
- development of urinary control
- preservation of normal kidney function
- avoidance of future sexual function problems
- improvement of physical appearance
- prevention of infection
Usually this surgery is done a few days after birth. However, the bladder needs to be big enough for surgery. If it is not, the surgery can be postponed. In such cases, the newborn baby is sent home with antibiotics. You will also be taught how to keep the bladder from becoming dry.
This procedure is usually performed before a newborn leaves the hospital. The hospital staff will do all of the necessary preparations.
If the surgery is postponed, however, tests may be needed. These include:
- urine tests to check for infection and kidney problems
- blood tests
- lower abdomen and pelvic X-rays
- kidney ultrasounds
You may also need to keep a record of how much urine your child is producing.
Be sure to tell the doctor about all medications your child is currently taking, including over-the-counter drugs. Ask which, if any, should be taken on the day of the surgery.
The doctor will most likely ask that your child not eat or drink anything in the hours leading up to the surgery. However, any necessary medication can be given with a little bit of water.
Your doctor will let you know when your child should arrive for the surgery.
Bladder exstrophy repair requires two separate surgeries.
In the first surgery, the surgeon separates the exposed bladder from the abdominal wall. Then, he closes the bladder and repairs the neck of the bladder and the urethra. He places a hollow tube called a catheter in the bladder so urine can be drained through the wall of the abdomen, and places another catheter to drain urine from the urethra. This promotes healing.
In the second surgery, the surgeon repairs the pelvic bone attachment. This may be done either right after the bladder repair or at a later time.
More surgeries are sometimes needed. This is particularly true if there is a defect in the bowel.
After the surgery, the infant will probably have to stay in the hospital for four to six weeks. During the first three to four weeks, they will have a catheter running from the bladder through the abdominal wall. This is used to drain urine.
Because surgery separated the pelvic bones, a cast or sling will be needed on the child’s lower body to promote healing. It will be in place for four to six weeks.
The infant will have wound care, pain management, and antibiotics as needed.
Urine samples will need to be checked at follow-up appointments. This is an easy way to detect any infection from the procedure.
When successful, the surgery results in:
- urinary control
- improved appearance of the genitals
- reduced problems with future sexual functioning
- prevention of kidney and other infections
However, the procedure is not always successful. Sometimes surgeries may need to be repeated.
In some cases, urinary control is never achieved. A catheter may be needed intermittently for the rest of the child’s life.
Risks associated with the repair include:
- inadequate urinary control, or incontinence
- urinary tract infections
- problems with sexual function
- problems with kidney function
- need for further surgeries
However, these problems are less likely than if a repair is not attempted.
In addition to these risks, there are risks associated with the use of anesthesia. These include problems breathing and adverse drug reactions.
Every surgery carries a risk of bleeding and infection.