Imaging case book: superior vesical fissure: variant classical bladder exstrophy

Superior Vesical Fissure as an Incomplete Form of Bladder Exstrophy: A Case Report with Clinico-Pathological Correlation and a Comprehensive Literature Review

Multiple variants of classic bladder exstrophy have been described, all of them infrequent. Superior vesical fissure is a mild variant of this pathology in which genital involvement is scarce or absent. To date, there are only isolated reports of this entity. We report a full-term female patient of Arabian descent with a clinical and radiological diagnosis of superior vesical fissure that was surgically corrected in our center with a favorable evolution. Histological study, supported by immunohistochemical techniques, showed squamous and transitional epithelium and discrete chronic inflammation. Our literature review identified 26 reports of superior vesical fissure (including ours), with high heterogeneity in terms of clinical characterization and associated malformations and with only two histological reports. The clinical evolution of the patients reported in the literature was favorable, with lower morbidity and mortality than in classical forms of bladder exstrophy.

Supravesical Fissure Variant of Bladder Exstrophy in a Female Patient: Case Report and Review of Literature

Variations from classic bladder exstrophy (BE) are extremely uncommon, resulting in distinctive challenges in both diagnosis and management. The supravesical fissure variant of BE is exceptionally rare and has only been reported in male patients to date. Herein, we report the case and surgical management of a supravesical fissure variant of BE presentation in a newborn female patient and provide a literature review of this exstrophy variant.

Pubic osteotomy minimal for abdominal wall closure in exstrophy bladder

We describe a novel 'pubic osteotomy minimal' (POM) done on body of pubis just lateral to the insertions of rectus abdominis and adductor longus muscles to bring rectus abdominis in midline without tension for abdominal wall closure without tension. In one patient, during pubic ramotomy, we missed middle of ramus and did osteotomy on the body on pubis found afterwards. Following good outcome, we did POM in another 17 patients. Abdominal wall closure was possible without tension and found satisfactory in all 18 patients in follow up. None had bladder wall dehiscence.