DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20201656

Bladder exstrophy with inguinal hernia: a case report

Tazeem Fatima Ansari, Prachi Gandhi, Poonam Wade, Vinaya Lichade Singh, Kiran Khedkar, Sushma Malik

Abstract


Exstrophy of urinary bladder with epispadias involves protrusion of the urinary bladder through a defect in the lower abdominal wall accompanied by separation of pubic symphysis. It is a rare but challenging condition that causes significant physical, functional, social, sexual and psychological problems later in life. Bladder exstrophy commonly involves males and most cases are sporadic.  Inguinal hernia is a complication associated with bladder exstrophy and it occurs due to lack of obliquity of the inguinal canal secondary to pubic diastasis.  Authors report here, a case of antenatally diagnosed case of classic bladder exstrophy associated with left sided inguinal hernia which was incidentally diagnosed on tenth day of life. Our neonate underwent primary bladder closure with herniotomy. Staged reconstruction of epispadias and bladder neck has been planned at a later date. Recurrence of inguinal hernia after repair is common and bilateral inguinal exploration while performing herniotomy is advised to prevent its recurrence. Prognosis of such cases depends on the degree of continence achieved. With timely reconstructive surgery, continence rates can be as high as 60-70 percent.


Keywords


Exstrophy, Epispadias, Herniotomy, Inguinal hernia

Full Text:

PDF

References


Ledbetter DJ, Chabra S, Javid PJ. Abdominal wall defects. In: Gleason CA, Juul SE (Eds). Averys diseases of the Newborn. 10th ed. Elsevier; 2018:1068-1078.

Siffel C, Correa A, Amar E, Bakker M, Bermejo-Sánchez E, Bianca S, et al. Bladder exstrophy: An epidemiologic study from the International Clearinghouse for Birth Defects Surveillance and Research, and an overview of the literature. Am J Med Genet Part C: Seminars Med Genetics. 2011;157(4):321-332.

Bird T, Hobbs C, Cleves M, Tilford J, Robbins J. National rates of birth defects among hospitalized newborns. Birth Defects Research Part A: Clinic Mol Teratol. 2006;76(11):762-9.

Nelson C, Dunn R, Wei J. Contemporary Epidemilogy of Bladder Exstrophy in the United States. J Urol. 2005;173(5):1728-31.

Fishel-Bartal M, Perlman S, Messing B, Bardin R, Kivilevitch Z, Achiron R et al. Early Diagnosis of Bladder Exstrophy: Quantitative Assessment of a Low-Inserted Umbilical Cord. J Ultrasound Med. 2017;36(9):1801-5.

Cacciari A, Pilu G, Mordenti M, Ceccarelli P, Ruggeri G. Prenatal Diagnosis of Bladder Exstrophy. J Urol. 1999;259-61.

Goldman S, Szejnfeld P, Rondon A, Francisco V, Bacelar H, Leslie B et al. Prenatal diagnosis of bladder exstrophy by fetal MRI. J Pediatr Urol. 2013;9(1):3-6.

Stringer M, Duffy P, Ransley P. Inguinal hernias associated with bladder exstrophy. Br J Urol. 1994;73(3):308-9.

Baird A, Nelson C, Gearhart J. Modern staged repair of bladder exstrophy: A contemporary series. J Pediatr Urol. 2007;3(4):311-5.

Bhatnagar V. Bladder exstrophy: An overview of the surgical management. J Indian Assoc of Pediatr Surg. 2011;16(3):81.

Elder JS. Anomalies of the Bladder. In: Kliegman RM, Stanton BF, Geme III JW, Schor NF, Behrman RE(Eds). Nelson textbook of Pediatrics. 20th ed. Elsevier; 2015:2575-2578.

Dellenmark-Blom M, Sjöström S, Abrahamsson K, Holmdahl G. Health-related quality of life among children, adolescents, and adults with bladder exstrophy–epispadias complex: a systematic review of the literature and recommendations for future research. Qual Life Res. 2019.

Boyadjiev S, Dodson J, Radford C, Ashrafi G, Beaty T, Mathews R, et al. Clinical and molecular characterization of the bladder exstrophy-epispadias complex: analysis of 232 families. BJU International. 2004;94(9):1337-43.

Lavien G, Di Carlo H, Shah B, Eifler J, Massanyi E, Stec A, et al. Impact of pelvic osteotomy on the incidence of inguinal hernias in classic bladder exstrophy. J Pediatr Surg. 2014;49(10):1496-9.

Pierre K, Borer J, Phelps A, Chow J. Bladder exstrophy: current management and postoperative imaging. Pediatr Radiol. 2014;44(7):768-6.

Connolly J, Peppas D, Jeffs R, Gearhart J. Prevalence and Repair of Inguinal Hernias in Children with Bladder Exstrophy. J Urol. 1995;1900-1.