A Prevalence Estimation of Exstrophy and Epispadias in Germany From Public Health Insurance Data

Failure of Prenatal Ultrasonography to Identify Classic Bladder Exstrophy in a Heavily Screened Population

OBJECTIVE

To summarize the imaging characteristics of newborns with bladder exstrophy and to identify the pitfalls that led to prenatal misdiagnosis.

METHODS

We evaluated prenatal ultrasonographic reports of all consecutive newborns with bladder exstrophy seen in our institution between 2017-2023. None had been diagnosed prenatally on early (14-16 weeks' gestation) and late (18-24 weeks' gestation) second trimester sonographic scans.

RESULTS

The study cohort included 14 patients after exclusion of four with insufficient information and one who was correctly diagnosed prenatally. All 14 had complete early and late second trimester scans. All had normal amniotic fluid volume. Biparietal diameter, head and abdominal circumferences, femur length, and fetal weight estimations were between 10-90 percentiles in both scans. All were erroneously diagnosed as having normal bladders, abdominal walls, and cord insertions. Two patients were diagnosed with suspected hypospadias in the late scan: both underwent a third directed scan and were again diagnosed with hypospadias without mention of other parts of the genitourinary tract.

CONCLUSION

Visualization of the filling of the bladder, meticulous examination of cord insertion and abdominal wall defects and a comprehensive examination of the genitourinary tract when there is a suspected penile anomaly can successfully identify cases of bladder exstrophy.

Bladder exstrophy-epispadias-cloacal exstrophy complex: characteristics, aetiologies, and epidemiologic findings

Bladder exstrophy-epispadias-cloacal exstrophy complex (BEEC) is a spectrum of congenital urologic anomalies that involve the bladder, urethra, genitalia, and pelvic musculoskeletal system, and can affect urinary continence, sexual health, and fertility. BEEC includes a wide spectrum of anatomical abnormalities with different levels of severity: epispadias represents the mildest phenotype, classic bladder exstrophy (CBE) is the most common defect, and cloacal exstrophy (CE) - often referred to as omphalocele, exstrophy, imperforate anus, and spinal defects (OEIS) complex - is the most severe form. BEEC disorders cause significant health problems and affect the health-related quality of life (QoL) of affected individuals. There have been significant insights into the aetiology of BEEC in the last decade. Specifically, recent genetic studies have suggested that downstream regulator(s) of p63, Isl1, and other genes may play a role in the failure of the lower urinary tract to close. This narrative review outlines the unique anatomy of bladder exstrophy (BE) and epispadias, with a brief mention of the anatomy found in CE. A literature review using PubMed and Google Scholar databases was used to identify relevant articles on the outlined topics without placing any limitations on publication years or study designs. We included full-text English articles published in peer-reviewed journals related to the terms: "exstrophy" & "epispadias" AND "aetiology", "embryology" and "incidence". We summarise the epidemiology of this rare complex - including what is known about its incidence in Africa - before presenting recent advances in comparative genetics from mouse models and human studies that provide insights into BEEC pathogenesis.

Birth prevalence of genital anomalies among males conceived by intracytoplasmic sperm injection cycles: A cross-sectional study

Background

Several studies have been conducted worldwide to evaluate the prevalence and relative risks of congenital anomalies associated with assisted reproductive technology cycles; however, there is limited data in Iran.

Objective

To investigate male genital anomalies among live births from assisted reproductive technology.

Materials and Methods

This cross-sectional study was conducted on children born after intracytoplasmic sperm injection (ICSI) at Royan Institute, Tehran, Iran from April 2013-December 2015. The prevalence of male genitalia disorders that included hypospadias, epispadias, cryptorchidism, micropenis, and vanishing testis were reported. The relationship between the cause of infertility and type of embryo transfer (fresh or frozen), gestational age at birth (term or preterm), and birth weight with these male genitalia anomalies were evaluated.

Results

In total, 4409 pregnant women were followed after their ICSI cycles to evaluate genitalia anomalies in their children. Out of 5608 live births, 2614 (46.61%) newborns were male, of which 14 cases (0.54%) had genital anomalies. The prevalence of various anomalies were cryptorchidism (0.34%), hypospadias (0.038%), micropenis (0.038%), vanishing testis (0.038%), and epispadias (0.077%). No relationship was found between the cause of infertility, type of embryo transfer (fresh or frozen), gestational age at birth (term or preterm), and male genital malformation (p = 0.33, p = 0.66, and p = 0.62, respectively).

Conclusion

The prevalence of each male genital anomaly after the ICSI cycle was rare and less than 0.5%; however, no significant infertility-related factor was observed with these anomalies.

A genome-wide association study with tissue transcriptomics identifies genetic drivers for classic bladder exstrophy

Classic bladder exstrophy represents the most severe end of all human congenital anomalies of the kidney and urinary tract and is associated with bladder cancer susceptibility. Previous genetic studies identified one locus to be involved in classic bladder exstrophy, but were limited to a restrict number of cohort. Here we show the largest classic bladder exstrophy genome-wide association analysis to date where we identify eight genome-wide significant loci, seven of which are novel. In these regions reside ten coding and four non-coding genes. Among the coding genes is EFNA1, strongly expressed in mouse embryonic genital tubercle, urethra, and primitive bladder. Re-sequence of EFNA1 in the investigated classic bladder exstrophy cohort of our study displays an enrichment of rare protein altering variants. We show that all coding genes are expressed and/or significantly regulated in both mouse and human embryonic developmental bladder stages. Furthermore, nine of the coding genes residing in the regions of genome-wide significance are differentially expressed in bladder cancers. Our data suggest genetic drivers for classic bladder exstrophy, as well as a possible role for these drivers to relevant bladder cancer susceptibility.

A genome-wide association study on classic bladder exstrophy reveals eight genome-wide significant loci, most of which contained genes expressed in embryonic developmental bladder stages.