Bladder Exstrophy
Bladder exstrophy is a rare midline closure defect where the bladder is open on the lower abdominal wall (part of the exstrophy–epispadias complex) — it requires staged or complete primary surgical reconstruction in specialist centres, aiming for secure abdominal/bladder closure, continence and acceptable genital reconstruction.
The big picture
Bladder exstrophy is a midline ventral defect in which the bladder fails to close and is everted onto the lower abdominal wall, with associated epispadias, a widened pubic symphysis (pelvic diastasis), and abnormal pelvic/abdominal-wall anatomy. It sits on a spectrum — the exstrophy–epispadias complex — ranging from isolated epispadias through classic bladder exstrophy to the most severe cloacal exstrophy (with bowel involvement). It is obvious at birth.
Bladder exstrophy is a midline exstrophy–epispadias-complex defect needing specialist staged/complete reconstruction — protect the bladder plate, refer to a specialist centre, and aim for closure, continence and genital reconstruction.
Symptom sorter
Recognise it.
Diagnostic algorithm
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Treatment ladder
Specialist, staged or complete reconstruction aiming for secure closure, continence, acceptable genitalia and renal protection.
Complications
- Incontinence, renal impairment, sexual/fertility and psychological issues, long-term bladder malignancy risk
- Closure failure/dehiscence, complications of osteotomy and reconstruction
- Specialist, high-volume care; secure closure; surveillance
- Redo/continence surgery; lifelong follow-up
Follow-up
- Continence, renal function and upper tracts
- Bladder capacity/function
- Long-term bladder malignancy risk; genital/cosmetic and psychological outcomes
- Lifelong specialist follow-up
- Secure closure, acceptable continence, protected kidneys, acceptable genitalia
- Failed closure, incontinence, renal deterioration
- Surveillance and on clinical change
- Incontinence needing further surgery, renal issues, malignancy risk, sexual/fertility and psychological considerations
Memory hooks
Open bladder on the abdominal wall = exstrophy.
Part of the exstrophy–epispadias complex.
Protect the plate; refer to a specialist centre.
Goals: closure, continence, genital reconstruction.
Lifelong surveillance (malignancy risk).
Board traps
Exstrophy is part of the exstrophy–epispadias complex.
Protect the plate and refer to a specialist centre.
Reconstruction goals: closure, continence, genital reconstruction.
Clinical cases
A newborn is born with the bladder mucosa visible and everted on the lower abdominal wall, with epispadias and a widened pubic symphysis.
What is the diagnosis and the immediate priority?