Exstrophy of the bladder - Causes, symptoms and treatment. MF.

Bladder exstrophy is a severe congenital anomaly of development, in which there is a defect in the anterior abdominal wall and a prolapse of the mucous membrane of the bladder to the outside.

Causes of bladder exstrophy

Bladder exstrophy is not the most frequent disease in urology, but since it gives very serious complications, its study in the clinic of urological diseases is mandatory. The only causative factor of bladder exstrophy is not present. In the development of the disease, many internal and external causes are involved, which can not be realized by every person.

First of all, pregnant women need to determine the level of hormones, since it is the dyshormonal disorders that quite often cause the development of congenital anomalies. Diabetes mellitus, pituitary gland tumor, adrenal hyperplasia, thyrotoxicosis are far from all diseases that can be the causes of the development of bladder exstrophy.

External factors include smoking, drinking alcohol, embryotoxic infections, the effects of certain chemicals and medications. In addition, in order to prevent the development of bladder exstrophy, pregnant women are advised to avoid exposure to radioactive radiation.

Scientists assign great importance in the development of bladder exstrophy to traumatic injuries. In their opinion, trauma is the most common causative factor in the development of not only exstrophy, but also many other congenital anomalies of the urinary system.

Bladder exstrophy symptoms

Bladder exstrophy is a disease with a pronounced clinical symptomatology. First of all, it is characterized by the absence of the anterior abdominal wall in the lower abdomen and the absence of the anterior wall of the bladder. Thus, the mucous membrane of the posterior wall of the bladder immediately falls to the surface. Naturally, in this case urine, which comes from the kidneys, is allocated not through the urethra, but through the defect it gets to the outside.

Bladder exstrophy

Constant irritation of the skin around a bladder defect immediately causes its inflammation. Clinically, it is characterized by redness and severe itching. But since the child is very small, the itching of his skin is manifested by deterioration of the general condition, irritability, rejection of the breast and poor weight gain.

It is foolish to talk about the need to consult a urologist for such a pathology, since it is diagnosed 100% of cases in the maternity ward, where the baby is sent for surgical treatment to the urological hospital.

Diagnosis of bladder exstrophy

Due to the characteristic clinical picture of the disease, the diagnosis of pathology is not particularly difficult. However, in order to be convinced that the defect leads to the bladder cavity, and not, say, to the stomach, it is necessary to conduct some additional studies. It is necessary to start with an examination of the anterior abdominal wall from the defect. With bladder exstrophy, urine is excreted in the analyzes, while in other pathologies peritoneal fluid or serous exudate can be found.

Very informative methods in this situation it is necessary to consider cystoscopy. The device in this case is inserted not through the urethra, but directly into the defect of the wall of the bladder. This allows us to estimate the size of the defect, and also to determine its location in relation to other important anatomical formations, such as the ureter or urethral opening.

Because bladder exstrophy can be associated with other serious pathologies of the internal organs, the child needs to conduct a number of additional studies to identify the latter. For example, with the help of ultrasound it is possible to identify the pathology of such organs as the kidneys, liver and spleen. In addition, computed tomography and endoscopy are used.

It is absolutely necessary to carry out a genetic examination of the child, since bladder exstrophy can often be a symptom of some genetic disease, such as Down syndrome or Edwards. Of course, it is better if this genetic analysis is performed during pregnancy.

Treatment of bladder exstrophy

It is natural that such an anomaly of development lends itself exclusively to surgical correction. Plastic surgery performed with bladder exstrophy is always very complicated and threatens to kill the patient. It should be noted that in order to close the defect of the anterior abdominal wall in a child, one does not always have enough of its own tissues, so it is necessary to apply a variety of operational techniques.

Classically, the first stage of surgical treatment is to eliminate the defect of the wall of the bladder. After this, if you have enough of your own abdominal wall tissues, the last one is closed. If the hole in the abdomen is too large and it is impossible to pull the tissues so tight to cover it, sterile polyethylene film is temporarily used.

Operative treatment of exstrophy

After a while, when the front abdominal wall begins to cover a little polyethylene film, repeated surgery is performed. In the course of the latter, the removal of the synthetic material and the stretching of the skin and tissues to the defect of the anterior abdominal wall are performed. It should be noted that it is not always possible to carry out the operation in two stages. Usually they are much more.

After surgery and during a life with a synthetic implant, active antibacterial therapy should be performed, since there is a very high risk of secondary infection. As a rule, children are assigned at once three groups of antibacterial agents. Most experts recommend using a combination of cephalosporins and fluoroquinolones with aminoglycosides. Neither are released at the pharmacy as prescribed by the doctor, and children are administered intravenously or intramuscularly in a hospital.

Rehabilitation after illness

People born with a similar developmental defect need preventive treatment of the genitourinary system throughout their life. They are recommended annually to visit such mineral resorts as Morshin or Polyana. In addition, it is extremely important to periodically undergo a full instrumental examination with a urologist, since even after a successful surgery, many long-term complications can occur.

Features of Nutrition and Lifestyle

Lifelong preventive treatment also applies to human nutrition. Such people are forbidden to eat salty, sharp or peppery foods. In addition, they are obliged to control their water regime, since excessive fluid intake threatens the development of renal complications.

As for the way of life, he, first of all, concerns the moment when the child is obliged to live with a polyethylene film instead of the front abdominal wall. At this time, parents need to learn how to properly care for the child. The implant itself, as such, does not need special care, but it is necessary to prevent its mechanical damage. If the child is restless, then he needs to cover his tummy with a soft blanket so that he can not hurt himself. Every day, the front abdominal wall should be carefully inspected for fluid transmission. If you find the slightest leak, you should immediately contact the urologist. As a rule, the defect can be eliminated without surgical intervention, although quite often it becomes the cause of an unscheduled operation.

Treatment with folk remedies

Since children with bladder exstrophy do not leave medical institutions from their birth, they simply can not physically fall into the hands of traditional healers. It only goes to their advantage, because it's scary even to imagine what would happen to a child in need of an immediate operation that fell into the hands of a healer.

Complications of bladder exstrophy

The number of complications of this disease depends on the moment of the operative intervention. First and foremost, doctors need to beware of hypothermia, that is, excessive heat loss. This is primarily due to the fact that the defect of the anterior abdominal wall, devoid of skin, is a very good conductor of heat. To prevent hypothermia in the first hours after the operation, the child must immediately be transferred to a kuvez. This device, which is a glass cap, is able to maintain the necessary temperature and humidity for the child.

The second danger that lies in wait for a baby with bladder exstrophy right after birth is septic complications. The defect of the anterior abdominal wall is the entrance gate to a pathogenic infection, which is simply full in the hospital, the first place of residence of a small patient. Therefore, all patients need to begin the course of antibacterial prophylaxis on the first day after birth, in order to avoid development, first peritonitis, and then sepsis.

In addition, there are secondary complications that develop after the operation. First of all, it is a commissural disease. Due to the large number of traumatic operations, a large amount of fibrin falls into the abdominal cavity, which eventually turns into fibrous adhesive bands. This can lead to severe pain syndrome and intestinal obstruction in the future.

Prophylaxis of bladder exstrophy

Prevention of this disease must be dealt with even before the birth of the child. First and foremost, it should be a medical genetic consultation, which makes it possible to determine such chromosomal pathologies as Down's syndrome or Edwards syndrome. Naturally, when making such a diagnosis, the most difficult task is for parents. They must decide whether to leave the child or not.

In addition, it is necessary to be examined for all embryotoxic infections. These include herpes, rubella, syphilis, toxoplasmosis and cytomegalovirus. If such diseases are detected during pregnancy, the woman should be prescribed a course of appropriate treatment. Along with this, it is necessary to ensure that during pregnancy, do not succumb to such pathological influences as smoking, drinking alcohol and drugs.

Rev.the doctor the urologist, the sexologist-andrologist Plotnikov А.N.