Bladder exstrophy repair

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

Definition

Bladder exstrophy repair is a surgery to repair bladder exstrophy. Exstrophy of the urinary bladder is an uncommon birth defect in which the bladder is exposed, inside out, and protrudes through the abdominal wall.

This defect also includes a separation of the pelvic bones. It occurs more often in boys. The condition is often associated with other congenital birth defects. Surgery to repair the defect is usually performed within the first 48 hours after birth.

Description

The first surgery needed is to separate the exposed bladder from the abdominal wall and close the bladder (bladder repair). The bladder neck and urethra are repaired. A flexible, hollow tube (catheter) is left in to drain the urine from the bladder through the abdominal wall. A second catheter is left in the urethra to promote healing.

Because the pelvic bones are separated, the child will also need to have the pelvic bones surgically attached to each other. After this surgery, the child will need to be in a lower body cast or sling to promote healing of the bones. This surgery may be done with the first surgery, or it may be delayed for weeks or months.

Indications
The surgery is recommended for children who are born with exposed and everted (exstrophied) bladders.

Risks
Risks for any anesthesia are:

• reactions to medications
  
• breathing problems

Risks for any surgery are:

• bleeding
  
• infection

Additional risks may include:

• chronic urinary tract infections
  
• inadequate urinary control (incontinence)
  
• need for future surgeries
  
• erectile/sexual dysfunction

Expectations after surgery
Surgery is necessary to:

• prevent infection that could decrease kidney function
  
• allow the child to develop normal urinary control
  
• improve the child’s physical appearance
  
• avoid future problems with sexual function

Some children are unable to develop adequate urinary control and may later need further urinary repair.

Convalescence
The length of hospitalization depends on how severe the defect is, if there are other problems, and how many stages of surgical correction are needed. Complete healing can take 4 to 6 weeks.

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