Results of surgical reconstruction in exstrophy of the bladder.

Abstract

Introduction Exstrophy of the urinary bladder is an infrequent congenital anomaly, estimated to occur approximately once in 40,000 births, predominantly in males. It is due to retarded development resulting in a deficient union of the lateral halves of the bladder and the structures which lie in front of it. The pubic bones do not fuse, and the flat mucous surface of the bladder, with its projecting ureteral orifices, makes up the floor of the deficit in the anterior abdominal wall. Complete epispadias is an accompanying feature. If the condition is untreated, danger of ascending infection is great, and pyelonephritis is frequently fatal early in life. The proposal of over 70 different methods of treatment indicates the difficulties inherent in successfully correcting this anomaly. For many years the treatment of choice has been some form of operative procedure to divert the urinary stream to the intestinal tract, although more recently primary