Strategy and tactics in the management of bladder exstrophy

Abstract

Bladder exstrophy is a severe and rare congenital malformation involving the abdominal wall, urinary tract, genitalia, and pelvic musculoskeletal structures. It remains a challenge for the pediatric urologist. Prenatal diagnosis is possible with routine ultrasound, but in most cases it is missed. The incidence is decreasing but not in low socioeconomic populations. The goal of surgery is to achieve urinary continence and preserve normal renal function with both functionally and cosmetically acceptable genitalia in order to reach a good quality of life. Different surgical techniques were proposed, but current management is well established, but some controversial points are neonatal versus delayed surgery and need, type, and timing of osteotomy procedure. Although modern techniques have improved the success of surgery, a baby with bladder exstrophy will undergo many operations, and the vast majority of these patients will eventually need augmentation cystoplasty and a clean intermittent catheterization to achieve urinary continence.