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Zhan J, Jia F, Gao Q, Xiao X. A case report of single umbilical artery combined with fetal bladder exstrophy in singleton pregnancy and related literature review. BMC Pregnancy Childbirth 2024; 24:122. [PMID: 38336714 PMCID: PMC10854176 DOI: 10.1186/s12884-024-06318-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 02/03/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND According to prenatal ultrasonographic studies, single umbilical artery may be present alone or in association with other fetal abnormalities. So far, the exact pathogenesis of bladder exstrophy is unclear. Some scholars believe that bladder exstrophy and cloacal exstrophy should be regarded as a disease spectrum to explore their pathogenesis. If bladder exstrophy and cloacal exstrophy are regarded as the same disease spectrum, then we can speculate that the single umbilical artery should have the probability of being accompanied by bladder exstrophy at the same time. CASE PRESENTATION For the first time, we report a rare case of fetal bladder exstrophy with single umbilical artery in single pregnancy. This patient underwent targeted color Doppler ultrasound at 26 weeks of pregnancy which first suspected bladder exstrophy with single umbilical artery and fetal MRI for diagnosis at 38 + 3 weeks of pregnancy which confirmed the suspicion. After the diagnosis was confirmed, the patient was scheduled for a multidisciplinary discussion. Ultimately the patient opted for induced fetal demise at 38 + 5 weeks of pregnancy and the physical appearance of the fetal demise affirmed previous ultrasound and MRI examination results. CONCLUSIONS Our report is the first finding of single umbilical artery combined with bladder exstrophy in a singleton pregnancy. Accordingly, our case enhances the evidence that cloacal exstrophy and bladder exstrophy should be treated as the same disease spectrum. In addition, we conducted a literature review on the diagnostic progress of single umbilical artery combined with bladder exstrophy, hoping to provide useful references for the diagnosis of this disease.
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Affiliation(s)
- Jun Zhan
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 20 Ren Min Nan Road, Chengdu, Sichuan, 610041, China
| | - Fenglin Jia
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 20 Ren Min Nan Road, Chengdu, Sichuan, 610041, China
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Qianqian Gao
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 20 Ren Min Nan Road, Chengdu, Sichuan, 610041, China
- Department of Ultrasound, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xue Xiao
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 20 Ren Min Nan Road, Chengdu, Sichuan, 610041, China.
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Alhussainan TS, Alahmari MS, Essa Ahmed F, Alshwieer MA, Aloqail TSA. Surgical Treatment of Late Developmental Dysplasia of the Hip in Bladder Exstrophy: A Case Report. JBJS Case Connect 2024; 14:01709767-202403000-00042. [PMID: 38452165 DOI: 10.2106/jbjs.cc.23.00635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
CASE We present a case of an 8-year-old boy with classical bladder exstrophy and a neglected right hip dislocation, exemplifying the risk of missed developmental dysplasia of the hip (DDH) in patients with exstrophy requiring careful orthopaedic oversight. CONCLUSIONS When treating patients with bladder exstrophy, physicians and surgeons should be vigilant not to miss associated DDH. If this condition requires surgical treatment, preoperative planning with computed tomography scans is vital to uncovering the complexities arising from abnormal pelvic and acetabular anatomy and ensuring successful treatment outcomes.
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Affiliation(s)
- Thamer S Alhussainan
- Department of Orthopedic Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Mousa Saeed Alahmari
- Department of Orthopedic Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Faris Essa Ahmed
- Department of Orthopedic Surgery, Al-Imam Abdulrahman Al-Faisal Hospital, First Health Cluster, Ministry of Health, Riyadh, Saudi Arabia
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Kamran H, Bitaraf M, Tanhaeivash R, Kajbafzadeh AM. Three-dimensional Computed Tomography Scan of the Pelvic Bone in Isolated Epispadias: Analysis Before Surgical Correction. Urology 2023; 180:235-241. [PMID: 37473922 DOI: 10.1016/j.urology.2023.05.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/30/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To determine intrapelvic angles and distances in pure epispadias patients and compare them to normal values. METHODS Using three-dimensional computed tomography, 17 intrapelvic dimensions (8 angles and 9 distances) were measured in 26 patients with pure epispadias (21 boys and 5 girls). These values were compared to normal values obtained from 6 patients (5 boys and 1 girl) who underwent either pelvic or abdominopelvic computed tomography for purposes unrelated to their bony pelvis. RESULTS Significant differences were observed in five angles (sacroiliac joint angle, S1 tilt angle, sacral curvature, superior-inferior rotation of the pelvis, and pubococcygeal angle; P-value=.016, .044, .011, .020, and .001, respectively); these show less sacral rotation toward the axial plane, more sacral curvature, inferior rotation of the pelvis, and sacroiliac joints' rotation toward the coronal plane in epispadias compared to controls. Also, two distances (pubic diastasis and anterior segment length of the pelvis; P-value=.002 and .012, respectively) had significant differences, showing wider pubic diastasis and shorter anterior segment in epispadias. However, the differences between other intrapelvic angles and distances were not statistically significant between the two groups. CONCLUSION In addition to the explanations hypothesized for the embryology of the exstrophy-epispadias complex, there can be other etiologies for both epispadias and bladder exstrophy to explain the differences between bony anatomies of the pelvis in these patients.
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Affiliation(s)
- Hooman Kamran
- Pediatric Urology and Regenerative Medicine Research Center, Gene, Cell and Tissue Research Institute, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoud Bitaraf
- Pediatric Urology and Regenerative Medicine Research Center, Gene, Cell and Tissue Research Institute, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Abdol-Mohammad Kajbafzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Gene, Cell and Tissue Research Institute, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
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Morrill CC, Haffar A, Crigger C, Black M, Jelin A, Nasr I, Gearhart JP. A Single-Institutional Experience With Prenatal Diagnosis of Cloacal Exstrophy: Room for Improvement. J Pediatr Surg 2023; 58:1949-1953. [PMID: 37179209 DOI: 10.1016/j.jpedsurg.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/24/2023] [Accepted: 04/13/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION A single institutional study characterizes the rate of prenatal diagnosis of cloacal exstrophy (CE) and examines its role on successful primary closures. MATERIALS AND METHODS An institutional database of 1485 exstrophy-epispadias patients was reviewed retrospectively for CE patients with confirmed presence/absence of prenatal diagnostics, primary exstrophy closure since 2000, institution of closure, and at least 1 year of follow up following closure. RESULTS The cohort included 56 domestic patients and 9 international patients. Overall, 78.6% (n = 44) of domestic patients were prenatally diagnosed while 21.4% (n = 12) were diagnosed postnatally. A positive trend was observed in the rate of prenatal diagnosis across the study period, 56.3%, 84.2%, 88.9% respectively (p = 0.025). Confirmatory fMRI was obtained in 40.9% (n = 18) of prenatally diagnosed cases. Patients diagnosed prenatally were found to be more likely to undergo treatment at exstrophy centers of excellence (72.1% v 33.3%, p = 0.020). Prenatal diagnosis was not predictive of increased rate of successful primary closure (75.6% vs 75.0%; p = 1.00; OR: 1.03, 95% CI: 0.23-4.58). Primary closures undertaken at exstrophy centers of excellence were significantly more likely to be successful compared to outside hospitals (90.9% v 50.0%, p = 0.002). CONCLUSIONS The rate of prenatal diagnosis of CE in patients referred for management to a high-volume exstrophy center is improving. Despite this improvement, patients continue to be missed in the prenatal period. While prenatal diagnosis offers the ideal opportunity to educate, counsel, and prepare expectant families, patients diagnosed at birth are not disadvantaged in their ability to receive a successful primary closure. Further research should investigate the benefit of patient referral to high-volume exstrophy centers of care to ensure optimal care and outcomes.
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Affiliation(s)
- Christian C Morrill
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, Douglas A. Canning MD Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Ahmad Haffar
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, Douglas A. Canning MD Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Chad Crigger
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, Douglas A. Canning MD Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Mara Black
- Department of Gynecology and Obstetrics, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Angie Jelin
- Department of Gynecology and Obstetrics, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Isam Nasr
- Division of Pediatric Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - John P Gearhart
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, Douglas A. Canning MD Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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Vinit N, Glénisson M, Chalouhi G, Salomon LJ, Millischer-Bellaiche AE, Beaudoin S, Blanc T. Prenatal diagnosis of unusual variant of exstrophy-epispadias complex. Ultrasound Obstet Gynecol 2023; 62:155-156. [PMID: 36704969 DOI: 10.1002/uog.26166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/05/2023] [Accepted: 01/17/2023] [Indexed: 06/06/2023]
Affiliation(s)
- N Vinit
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- EA FETUS 7328-LUMIERE, Imagine Institute, Necker-Enfants Malades Hospital, Paris, France
- Université Paris Cité, Paris, France
| | - M Glénisson
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- Université Paris Cité, Paris, France
| | - G Chalouhi
- EA FETUS 7328-LUMIERE, Imagine Institute, Necker-Enfants Malades Hospital, Paris, France
- Department of Obstetrics, Fetal Medicine, Surgery and Imaging, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - L J Salomon
- EA FETUS 7328-LUMIERE, Imagine Institute, Necker-Enfants Malades Hospital, Paris, France
- Université Paris Cité, Paris, France
- Department of Obstetrics, Fetal Medicine, Surgery and Imaging, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - A-E Millischer-Bellaiche
- EA FETUS 7328-LUMIERE, Imagine Institute, Necker-Enfants Malades Hospital, Paris, France
- Department of Pediatric Radiology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - S Beaudoin
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- Université Paris Cité, Paris, France
| | - T Blanc
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- Université Paris Cité, Paris, France
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Aneja K, Bhalla AA, Nanda A, Khurana A. Color Doppler evaluation of umbilical arteries in relation to bony landmarks in the fetal pelvis as a clue to the mid-trimester diagnosis of bladder exstrophy: A novel observation. J Clin Ultrasound 2023; 51:644-651. [PMID: 36972256 DOI: 10.1002/jcu.23455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/22/2023] [Accepted: 03/13/2023] [Indexed: 05/03/2023]
Abstract
Color Doppler (CD) is an established diagnostic modality for bladder exstrophy. We present two mid-trimester difficult-to-diagnose cases with no obvious infraumbilical mass bulge, assessed by CD in sagittal and axial pelvic views. The first case was a classical bladder exstrophy at 19 weeks nestled under the umbilical-cord and the second case was an omphalocele-exstrophy-imperforate-anus-spinal complex at 18 weeks 4 days gestation with exstrophic bladder embedded under the omphalocele. The altered course of umbilical arteries in relation to pelvic bony landmarks seen in these fetuses could be an objective approach to complement mid-trimester diagnosis of bladder exstrophy regardless of mass bulge.
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Affiliation(s)
- Kavita Aneja
- Images Ultrasound Centre, Naveda Healthcare Centre, House Number 81, Pocket A1, Sector 8 Rohini, New Delhi, India
| | | | - Anupam Nanda
- Department of Radiology, Nanda Diagnostics, Saraswati Vihar, Pitampura, New Delhi, India
| | - Ashok Khurana
- Department of Radiology, The Ultrasound Lab, New Delhi, India
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Tankam CS, Peterson MR, Tachie-Baffour Y, Zammar S, Rizk EB. Fatty filum terminale and low-lying conus medullaris in Gollop-Wolfgang complex: a case report and review of literature. Childs Nerv Syst 2023; 39:517-526. [PMID: 36155841 DOI: 10.1007/s00381-022-05679-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/15/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND/IMPORTANCE Gollop-Wolfgang complex is a rare skeletal dysplasia with only 200 cases reported in the literature. This disorder is usually associated with several extraosseous anomalies. This report describes the first case of a fatty filum terminale and a low-lying conus medullaris in a patient with this complex. A review of the current literature of the Gollop-Wolfgang complex accompanies this case, highlighting the documented extraosseous anomalies seen in this complex. CLINICAL PRESENTATION We report a case of an 18-month-old patient with Gollop-Wolfgang complex who underwent cord untethering with release of the filum terminale after extensive workup showed the presence of a dyssynergic bladder and radiological evaluation revealed a fatty filum terminale and low-lying conus medullaris. CONCLUSION Gollop-Wolfgang complex is a skeletal dysplasia usually associated with several extra skeletal anomalies. Our report describes the first case of a fatty filum terminale and low-lying conus medullaris in this complex, as well as provides an overview of the documented anomalies seen in this disorder. A multidisciplinary approach is recommended when treating these infants in order to ensure that occult manifestations of the complex are not missed.
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Affiliation(s)
- Cyril S Tankam
- Department of Neurosurgery, Penn State Children's Hospital, 30 Hope Drive, Suite 1200, Building B, Hershey, PA, 1733, USA.
| | - Mallory R Peterson
- Department of Neurosurgery, Penn State Children's Hospital, 30 Hope Drive, Suite 1200, Building B, Hershey, PA, 1733, USA
| | - Yaw Tachie-Baffour
- Department of Neurosurgery, Penn State Children's Hospital, 30 Hope Drive, Suite 1200, Building B, Hershey, PA, 1733, USA
| | - Samer Zammar
- Department of Neurosurgery, Penn State Children's Hospital, 30 Hope Drive, Suite 1200, Building B, Hershey, PA, 1733, USA
| | - Elias B Rizk
- Department of Neurosurgery, Penn State Children's Hospital, 30 Hope Drive, Suite 1200, Building B, Hershey, PA, 1733, USA
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Ozcan T, Woo L, Wien M, Lazebnik N. Prenatal ultrasound findings of covered bladder exstrophy and persistent cloaca. J Clin Ultrasound 2021; 49:834-837. [PMID: 34235755 DOI: 10.1002/jcu.23036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/19/2021] [Accepted: 06/27/2021] [Indexed: 06/13/2023]
Abstract
Unlike classic exstrophy, covered bladder exstrophy is a rare variant characterized by a cycling bladder and intact abdominal wall. We present a case of covered bladder exstrophy diagnosed prenatally and associated persistent cloaca (PC) noted only after delivery. This case report demonstrates that prenatal diagnosis of covered bladder exstrophy is possible and PC can present without any abdominal cysts, bowel, or renal findings. Covered bladder exstrophy should be considered in the differential of cystic protrusion of the bladder to the abdominal wall.
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Affiliation(s)
- Tulin Ozcan
- Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Lynn Woo
- Department of Pediatric Urology, Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Michael Wien
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Noam Lazebnik
- Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Fishel-Bartal M, Perlman S, Messing B, Bardin R, Kivilevitch Z, Achiron R, Gilboa Y. Early Diagnosis of Bladder Exstrophy: Quantitative Assessment of a Low-Inserted Umbilical Cord. J Ultrasound Med 2017; 36:1801-1805. [PMID: 28436540 DOI: 10.1002/jum.14212] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 11/08/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Bladder exstrophy is a rare severe congenital malformation. Early prenatal diagnosis is scarcely described in the literature. Low insertion of the umbilical cord is a constant anatomic feature of bladder exstrophy. The aim of our study was to assess whether early measurements of the umbilical cord insertion-to-genital tubercle length may serve as quantitative measurements for a low-inserted umbilical cord in cases of bladder exstrophy. METHODS The umbilical cord insertion-to-genital tubercle length was prospectively measured in all cases referred for a nonvisualized urinary bladder before 18 weeks' gestation. Final diagnoses were compared with prenatal measurements. RESULTS Fifteen fetuses were evaluated for a nonvisualized bladder at a mean gestational age of 15.7 weeks (range, 14-17 weeks). Of them, 6 cases were diagnosed with bladder exstrophy, and 9 cases had a normal urinary bladder. All cases with bladder exstrophy had an umbilical cord insertion-to-genital tubercle length below the fifth percentile for gestational age, whereas cases with a normal bladder had a normal measurement. CONCLUSIONS Fetuses with bladder exstrophy have an umbilical cord insertion-to-genital tubercle length below the fifth percentile of the general population. This measurement may serve as a complementary objective sonographic parameter in the prenatal assessment and counseling of cases suspected of having bladder exstrophy during early pregnancy.
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Affiliation(s)
- Michal Fishel-Bartal
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sharon Perlman
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Baruch Messing
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ron Bardin
- Ultrasound Unit, Department of Obstetrics and Gynecology, Rabin Medical Center, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Zvi Kivilevitch
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Reuven Achiron
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yinon Gilboa
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Bronshtein M, Gilboa Y, Gover A, Beloosesky R. Direct lower abdominal ureteral jet as sonographic sign of bladder exstrophy. Ultrasound Obstet Gynecol 2017; 49:412-413. [PMID: 26935992 DOI: 10.1002/uog.15906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 02/18/2016] [Accepted: 02/26/2016] [Indexed: 06/05/2023]
Affiliation(s)
- M Bronshtein
- Department of Obstetrics and Gynecology, Rambam Medical Center, Ha'alya Ha'Shnya 8, Haifa, Israel
- Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Y Gilboa
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - A Gover
- Neonatal Intensive Care Unit, Lady Davis Carmel Medical Center, Haifa, Israel
| | - R Beloosesky
- Department of Obstetrics and Gynecology, Rambam Medical Center, Ha'alya Ha'Shnya 8, Haifa, Israel
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Pastor-Navarro H, Carrión-López P, Martínez-Ruiz J, Pastor-Guzmán J, Martínez-Verduch M, García-Ibarra F, Virseda-Rodríguez JA. [BLADDER EXSTROPHY AND RECTAL BLADDER]. ARCH ESP UROL 2015; 68:509. [PMID: 26554051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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12
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Rudzinska M, Bijok J, Tomaszewska K, Massalska D, Gastol P, Ostrowska J, Jakiel G, Roszkowski T. Skin-covered bladder exstrophy diagnosed antenatally. J Ultrasound Med 2013; 32:2043-2045. [PMID: 24154910 DOI: 10.7863/ultra.32.11.2043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Goyal A, Fishwick J, Hurrell R, Cervellione RM, Dickson AP. Antenatal diagnosis of bladder/cloacal exstrophy: challenges and possible solutions. J Pediatr Urol 2012; 8:140-4. [PMID: 21641871 DOI: 10.1016/j.jpurol.2011.05.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 05/10/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To identify the pitfalls in accurate antenatal diagnosis of bladder exstrophy (BE) and cloacal exstrophy (CE), and thus understand the challenges for antenatal counselling. METHODS A prospectively maintained bladder exstrophy database of antenatal and live born referrals for BE/CE was used to identify patients. Data were collected about the antenatal scan findings and the outcome of pregnancy. RESULTS Between 2003 and 2009, 40 new babies with BE/CE were referred and of them 10 had an antenatal diagnosis. Five patients did not have a diagnosis despite suspicious findings noted on antenatal scans and another three had a wrong diagnosis of BE/CE. Of the 16 referrals with antenatal suspicion of BE/CE, 5 opted for termination. At the 20-week scan, it was possible to identify the gender of the fetus in 3/16 cases only. CONCLUSIONS Only a quarter of the babies born with BE/CE had received an antenatal diagnosis. Raising awareness about the condition amongst radiographers, and facilitating further scanning by a specialist fetal management unit if suspicious findings are noted, is crucial for improving the rate of detection. An antenatal diagnosis may not be reliable, and difficulty in identifying gender at the 20-week scan adds to the complexity of antenatal counselling. Magnetic resonance imaging and karyotyping may provide additional helpful information.
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Affiliation(s)
- Anju Goyal
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Oxford Road, Manchester M13 9WL, UK.
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Gilboa Y, Katorza E, Kedem A, Spira M, Achiron R. Measurement of the fetal umbilical cord insertion-to-genital tubercle length in early gestation: in utero sonographic study. J Ultrasound Med 2011; 30:237-241. [PMID: 21266562 DOI: 10.7863/jum.2011.30.2.237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES The purpose of this study was to establish in utero reference ranges for the fetal umbilical cord insertion-to-genital tubercle length in early gestation. METHODS A prospective cross-sectional study was performed on 140 normal low-risk singleton pregnancies between 12 and 18 weeks' gestation. The umbilical cord insertion-to-genital tubercle length was measured in a midsagittal section with high-resolution transvaginal or transabdominal sonography. The mean and 95% prediction limits were defined for each gestational week and analyzed by regression equations and correlation coefficients. RESULTS Adequate measurements were obtained in 134 patients. The umbilical cord insertion-to-genital tubercle length as a function of gestational age was expressed by the following regression equation: umbilical cord insertion-to-genital tubercle length = -3.079452 + 1.09 × week (R(2) = 0.7117). The correlation R(2) = 0.7117 was found to be highly statistically significant (P < .001). The normal mean and 95% prediction limits were defined for each gestational week. During the study period, 2 cases were referred to our unit because of nonvisualization of the urinary bladder. The umbilical cord insertion-to-genital tubercle lengths in these cases were below the 95th percentile, confirming the diagnosis of bladder exstrophy. CONCLUSIONS The normative data established in this study may be helpful for early pre-natal diagnosis congenital bladder exstrophy.
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Affiliation(s)
- Yinon Gilboa
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel.
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Ono K, Kikuchi A, Takagi K, Takahashi D, Yoshizawa K, Nishizawa S. Prenatal sonographic features of complete covered cloacal exstrophy. Ultrasound Obstet Gynecol 2009; 34:481-482. [PMID: 19790101 DOI: 10.1002/uog.7346] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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16
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Ebert AK, Falkert A, Germer U, Rösch WH. Biometry of the pubovisceral muscle and levator hiatus assessed by three-dimensional ultrasound in females with bladder exstrophy-epispadias complex after functional reconstruction. Ultrasound Obstet Gynecol 2009; 34:98-103. [PMID: 19565527 DOI: 10.1002/uog.6429] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The congenital bony and musculoskeletal defect of the pelvis in bladder exstrophy-epispadias complex (BEEC) highly predisposes females to uterine prolapse. There is a paucity of knowledge on the anatomy of the pelvic soft tissue structures following surgery. The aim of this study was to investigate with transperineal three-dimensional (3D) ultrasound the pubovisceral muscle in females with BEEC who had undergone surgical reconstruction in childhood. METHODS In a cross-sectional observational study we examined 12 Caucasian female BEEC patients, mean age 19.9 (range, 15.5-27.4) years, from a single center after a single-stage functional reconstruction with closure of the anterior pelvic ring. As a control group we used 13 Caucasian nulligravidae. 3D transperineal ultrasound volumes were acquired with the patient at rest in the supine position and with an empty bladder, and established pelvic floor parameters were measured. Analysis was conducted offline by two independent investigators. RESULTS No statistical difference between the BEEC patients and the control group was observed in the anteroposterior diameter or the area of the levator hiatus, or in the maximal thickness of the levator muscle. However, significantly greater values were observed in BEEC patients in the transverse diameter of the levator hiatus (mean, 4.31 vs. 3.81 cm, P = 0.046) and in the levator angle (mean, 80.1 vs. 70.0 degrees, P = 0.040). The measurements obtained in the control group were consistent with those previously reported in the literature. CONCLUSIONS This is the first study showing that transperineal 3D ultrasound can be used for the assessment of BEEC patients after functional reconstruction. Biometric pelvic floor parameters may be useful in the long-term follow-up of BEEC patients.
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Affiliation(s)
- A K Ebert
- Department of Paediatric Urology, University Medical Centre Regensburg, Regensburg, Germany.
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17
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Mabille M, De Laveaucoupet J, Senat MV, Picone O, Levaillant JM, Mas AE, Musset D. Imaging of the fetal bony pelvis by computed tomography in a case of bladder exstrophy. Ultrasound Obstet Gynecol 2009; 33:716-719. [PMID: 19479679 DOI: 10.1002/uog.6409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We describe the findings on computed tomography (CT) in a prenatally diagnosed case of bladder exstrophy, and compare them with the findings on two- and three-dimensional sonography. The CT data of the affected fetus were compared with the CT findings of 14 fetuses with normal bony pelvises. The CT images showed differences in the structure of the bony pelvis in the case of bladder exstrophy, with a wide gap between the iliopubic and ischiopubic rami and a widening of the iliac bones. CT scanning was useful in confirming the sonographic diagnosis of bladder exstrophy, and it may also be helpful for planning early surgery following delivery.
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Affiliation(s)
- M Mabille
- Service de Radiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Antoine Béclère, Clamart, France.
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18
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Wax JR, Pinette MG, Smith R, Cartin A, Blackstone J. First-trimester prenatal sonographic diagnosis of omphalocele-exstrophy-imperforate anus-spinal defects complex. J Clin Ultrasound 2009; 37:171-174. [PMID: 18726969 DOI: 10.1002/jcu.20520] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We describe a case of omphalocele-exstrophy-imperforate anus-spinal defects (OEIS) diagnosed at 13 weeks' gestation by ultrasound detection of a large multilocular ventral wall mass into which inserted the umbilical cord, and thoracic hemivertebrae with kyphoscoliosis. Subsequent sonographic examinations at 16 and 19 weeks revealed evolution of the ventral wall mass into a classic omphalocele. Clinicians should recognize the significance of a large multicystic ventral wall mass, which should lead to a search for other anomalies suggestive of OEIS complex.
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MESH Headings
- Abnormalities, Multiple/diagnosis
- Abnormalities, Multiple/diagnostic imaging
- Abortion, Eugenic
- Adult
- Anus, Imperforate/diagnosis
- Anus, Imperforate/diagnostic imaging
- Bladder Exstrophy/diagnosis
- Bladder Exstrophy/diagnostic imaging
- Female
- Fetal Diseases/diagnostic imaging
- Hernia, Umbilical/diagnosis
- Hernia, Umbilical/diagnostic imaging
- Humans
- Pregnancy
- Pregnancy Trimester, First
- Spinal Diseases/diagnosis
- Spinal Diseases/diagnostic imaging
- Spine/abnormalities
- Spine/diagnostic imaging
- Ultrasonography, Doppler, Color
- Ultrasonography, Prenatal/methods
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Affiliation(s)
- Joseph R Wax
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center, 887 Congress Street, Suite 200, Portland, ME 04102, USA
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19
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Hassid VJ, Kerwin AJ, Schinco MA, Tepas JJ, Frykberg ER. Congenital anomalies presenting as acute orthopedic trauma. J Trauma 2008; 64:1145. [PMID: 18404089 DOI: 10.1097/ta.0b013e31803e8c7c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Victor J Hassid
- Department of Surgery, University of Florida, HSC/Jacksonville, Florida, USA.
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20
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21
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Abstract
Little information is available concerning the acetabular morphology in adults with a history of bladder exstrophy. We documented the pelvic anatomy in adult patients with bladder exstrophy who never had prior surgery. We retrospectively reviewed 31 patients (62 hips) seen from 1976 to 2003 for urologic problems related to bladder exstrophy without adjunctive pelvic osteotomy. There were 18 males and 13 females with an average age of 30 years at last followup. Radiographs at final followup were analyzed for lateral center-edge angle, acetabular index, head extrusion, hip center of rotation, acetabular version, retroversion index, sacral width, and interteardrop distance. Most hips (60 hips) had no arthritis. The average lateral center-edge angle, ace-tabular index, and head extrusion index were 32 degrees, 5.7 degrees, and 0.266%, respectively. Fifty-eight percent of hips had a retroverted acetabulum and 42% were neutral or anteverted. The interteardrop distance averaged 154 mm. Most patients will not have early arthritis develop, and the majority of patients (58%) have retroverted orientation of the acetabulum.
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Affiliation(s)
- Alexandre Nehme
- Department of Orthopaedics, Mayo Clinic, Rochester, MN 55905, USA
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22
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Hong R, Lim SC, Jang JW, Suh CH, Jeon HJ, Lee MJ, Kim YS. OEIS complex with glomerulocystic kidney disease: a case report. Pediatr Dev Pathol 2007; 10:121-4. [PMID: 17378687 DOI: 10.2350/06-05-0092.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2006] [Accepted: 07/07/2006] [Indexed: 02/07/2023]
Abstract
We present a case of OEIS complex (omphalocele, exstrophy of bladder, imperforated anus, spinal defect) combined with colonic agenesis and glomerulocystic kidney disease (GCKD). The baby was born at 35.2 weeks of gestational age, weighing 2.51 kg. A prenatal ultrasound examination showed spina bifida, hydroureter, and a unilateral polycystic kidney. The postdelivery examination, which included a physical examination, simple X-ray, and pelvic MRI, showed a lower abdominal wall defect through which a small pouch with a segment of bowel protruded, imperforated anus, ambiguous external genitalia, spina bifida with meningomyelocele at the lumbosacral junction, and nonunion of pubic symphysis. The baby underwent surgery, including nephrectomy, colostomy, and repair of the abdominal wall defect. In addition to the abnormalities mentioned, a tailgut as a result of colonic agenesis and 2 appendices were identified in the course of surgery. The result of histopathological examination confirmed the polycystic kidney identified as GCKD. These radiological, surgical, and histopathologic findings are consistent with the OEIS complex. The postoperative course was uneventful during a period of 4 months of follow up. We herein report a case of the very rare OEIS complex in a newborn male baby and review the available literature.
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Affiliation(s)
- Ran Hong
- College of Medicine, Chosun University, Gwangju, Korea
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23
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Affiliation(s)
- T E Herman
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis Children's Hospital, St Louis, MO 63110, USA.
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24
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Ben-Neriah Z, Withers S, Thomas M, Toi A, Chong K, Pai A, Velscher L, Vero S, Keating S, Taylor G, Chitayat D. OEIS complex: prenatal ultrasound and autopsy findings. Ultrasound Obstet Gynecol 2007; 29:170-7. [PMID: 17221944 DOI: 10.1002/uog.3874] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To describe prenatal ultrasound and autopsy findings in fetuses with OEIS (omphalocele, bladder exstrophy, imperforate anus, spina bifida) complex. METHODS This was a retrospective study of the nine cases with OEIS complex diagnosed at our center using detailed fetal ultrasound during the last 10 years. We summarized the fetal ultrasound findings that led to the diagnosis and compared them with the autopsy results. RESULTS All affected fetuses were diagnosed using detailed fetal ultrasound after 16 weeks' gestation. The main prenatal findings were omphalocele, skin-covered lumbosacral neural tube defect, non-visualized bladder and limb defects. Prenatal sonography failed to detect the abnormal genitalia, bladder exstrophy and anal atresia. All cases had abnormalities in a 'diaper distribution', which helped in making the prenatal diagnosis. Eight of the nine couples chose to terminate the pregnancies following multidisciplinary counseling. The pregnancy that was continued was a case with dizygotic twins discordant for OEIS, and the affected fetus died in utero. CONCLUSIONS The combination of the following ultrasound findings: ventral wall defect, spinal defect and a non-visualized bladder with or without limb defects, are characteristic of OEIS complex. Diagnosis can be made with confidence as early as 16 weeks' gestation, although earlier diagnosis may be possible.
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Affiliation(s)
- Z Ben-Neriah
- The Department of Human Genetics, Hadassah Medical Center, The Hebrew University, Jerusalem, Israel
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Tapre P, Sen S, Chacko J, Karl S. The use of refluxing ureter in the creation of a Mitrofanoff channel in children undergoing bladder augmentation: is a formal reimplantation necessary? Pediatr Surg Int 2006; 22:250-4. [PMID: 16308705 DOI: 10.1007/s00383-005-1552-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2005] [Indexed: 10/25/2022]
Abstract
To study the fate of a refluxing ureteral stump used as a Mitrofanoff channel (MC) for clean intermittent catheterization (CIC), without reimplantation in augmented bladders. Ten boys and seven girls, 1-14 years old (mean 6.5 years) seen in period 1998-2005, underwent creation of MC using refluxing or potentially refluxing ureters. Concomitant bladder augmentation (BA) was performed for various abnormalities of lower urinary tract, including exstrophy epispadias complex, neurogenic bladder cloaca and posterior urethral valve. The uretero-vesical junction was maintained intact during creation of the MC. Follow-up period ranged from 2-72 months (mean 32.5 months). Satisfactory CIC was possible in 14 children while in two children the stoma became obstructed due to non-usage. Urinary leak via the ureteric MC was seen in only one patient who partially responded to anticholinergic therapy and a shortened CIC interval but this needed to be formally closed subsequently. A refluxing ureter can be used in the creation of a MC without formal reimplantation in the majority of children undergoing BA.
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Affiliation(s)
- Parag Tapre
- Department of Paediatric Surgery, Christian Medical College and Hospital, 632004 Vellore, TN, India
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26
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Vasudevan PC, Cohen MC, Whitby EH, Anumba DOC, Quarrell OWJ. The OEIS complex: two case reports that illustrate the spectrum of abnormalities and a review of the literature. Prenat Diagn 2006; 26:267-72. [PMID: 16450352 DOI: 10.1002/pd.1394] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We present two cases of OEIS (omphalocele, exstrophy, imperforate anus, spinal defects) complex -MIM 258040 and a review of the literature. Case 1 was a 14-year-old girl who presented at 30 weeks' gestation. An ultrasound examination showed an omphalocele and spina bifida; the bladder was not visualised. She went into spontaneous labour two weeks later and the baby died shortly after birth. A full post-mortem examination was refused, but the mother did agree to an external examination, skin biopsy for fibroblast culture, X rays and MR imaging. The MR imaging showed a pelvic kidney, a large omphalocele containing the other kidney, liver, bowel and a fluid filled structure thought to represent an exstrophy of the bladder (EB). Case 2 was a 30-year-old woman who had an ultrasound examination at 20 weeks' gestation; this showed an omphalocele, but the bladder was not visualised. The pregnancy was subsequently terminated and a post-mortem examination showed a low set umbilical cord associated with a small omphalocele; there was an imperforate anus; a blind ending rectum terminated in the omphalocele. We conclude that these two cases illustrate the variability of the OEIS complex.
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Affiliation(s)
- Pradeep C Vasudevan
- Department of Clinical Genetics, Sheffield Children's Hospital, Sheffield, UK.
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27
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El-Mowafi H, El-Sherbiny M, Abou-ElGhar M, Hafez A. Acetabular coverage in bladder exstrophy: role of 3-dimensional computed tomography. Acta Orthop Belg 2005; 71:410-3. [PMID: 16184994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
We studied the acetabular coverage in bladder exstrophy patients and normal control children. The study included 13 patients with bladder exstrophy, who were divided according to their ages into group I below 5 years, group II between 5 and 10 years, and group III above 10 years of age. Four normal children served as controls, 2 were below 5 years, one was 7 and one was 12 years old. We measured the acetabular coverage (AC) and the center-edge-angle (CEA) by utilising the reconstructed 3-dimensional CT images. The mean right and left AC angles were 82 +/- 12 and 82 +/- 20 degrees in group-I, 107 +/- 15 and 103 +/- 17 in group-II and 119 +/- 24 and 116 +/- 22 in group-lII, respectively (p < 0.05). The mean right and left CEA angles were 33 +/- 4 and 32 +/- 4 degrees in group-I, 30 +/- 4 and 29 +/- 5 in group-II and 25 +/- 2 and 24 +/- 1 in group-III, respectively (p < 0.05). In controls, the mean right and left AC angles were 151 +/- 2 and 153 +/- 2 degrees for children below 5 years, 166 and 165 degrees in the 7 year-old child and 180 and 180 degrees in the 12 year-old child. The CEA angle ranged from 15 to 25 degrees. Acetabular coverage in bladder exstrophy patients is deficient during the first 5 years of life. Although it gradually improves over time, it does not reach to normal value.
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Affiliation(s)
- Hani El-Mowafi
- Mansoura University Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt.
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28
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Romeo C, Arena F, Impellizzeri P. [Prenatal diagnosis of pelvic floor malformations]. Pediatr Med Chir 2005; 27:59-63. [PMID: 16910452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
Pelvic floor malformations are congenital defects in the pelvic and perineal area, which are derived from a defective development of the cloaca membrane, the uro-rectal septum, the mesonephric and para-mesonephric ducts and the urogenital sinus. These are complex anomalies with a profound emotional impact on parents. The prenatal diagnosis is possible favoring the prenatal counseling for the parents and expediting the post-natal evaluation and management. Aim of the present paper is to review the current criteria for the prenatal diagnosis of the following malformations: anorectal anomalies, cloacal anomalies, persistence of the urogenital sinus, bladder and cloacal exstrophy and ambiguous genitalia.
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Affiliation(s)
- Carmelo Romeo
- Dipartimento di Scienze Pediatriche Mediche e Chirurgiche, Università degli Studi di Messina
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Della Monica M, Nazzaro A, Lonardo F, Ferrara G, Di Blasi A, Scarano G. Prenatal ultrasound diagnosis of cloacal exstrophy associated with myelocystocele complex by the ‘elephant trunk-like’ image and review of the literature. Prenat Diagn 2005; 25:394-7. [PMID: 15909284 DOI: 10.1002/pd.1146] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A case of cloacal exstrophy (CE) was detected by ultrasound as early as 22 weeks of gestation in association with myelocystocele complex, an unusual form of occult spinal dysraphism often associated with such a disease. The ultrasonographic diagnosis was made through the detection of a wavy cord-like segment of soft tissue protruding from the anterior abdominal wall, just below the umbilical cord insertion, strongly resembling the trunk of an elephant. Our article enforces the suggestion that the ultrasound elephant trunk-like image should be added to the existing major criteria for making prenatal diagnosis of CE.
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Wu JL, Fang KH, Yeh GP, Chou PH, Hsieh CTC. Using color Doppler sonography to identify the perivesical umbilical arteries: a useful method in the prenatal diagnosis of omphalocele-exstrophy-imperforate anus-spinal defects complex. J Ultrasound Med 2004; 23:1211-1215. [PMID: 15328436 DOI: 10.7863/jum.2004.23.9.1211] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To describe the different prenatal sonographic findings in 3 cases of omphalocele-exstrophy-imperforate anus-spinal defects (OEIS) complex, or cloacal exstrophy. METHODS Three patients with OEIS complex were examined by sonography. In 2 (cases 2 and 3) of the 3 cases, color Doppler sonography was applied to the area of cord insertion and the abdominal mass to determine the origin of the abdominal mass. RESULTS Three cases of OEIS complex with different sonographic appearances are included in this series. An absent bladder without an abdominal mass but with bowel floating in the amniotic cavity was revealed in case 1; an absent bladder with a lower anterior abdominal mass was found in the second trimester in case 2; and a large cystlike mass located in the anterior abdominal wall was found in case 3. Color Doppler imaging showed that the abdominal mass originated from the urinary bladder in cases 2 and 3; therefore, OEIS complex was presumptively diagnosed antenatally in these cases. In all cases, OEIS complex was confirmed postnatally. CONCLUSIONS Omphalocele-exstrophy-imperforate anus-spinal defects complex should be considered in patients with an absent bladder combined with either an anterior abdominal wall mass or defects. Special attention should be given to search for other combined anomalies. We suggest that color Doppler sonography for identifying the perivesical umbilical arteries is a very useful method in establishing of the diagnosis of OEIS complex.
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Affiliation(s)
- Joung-Liang Wu
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, 135 Nanhsiao St, 500, Taiwan, Republic of China
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Abstract
OBJECTIVE Exstrophy of the bladder is a rare malformation due to an anterior midline defect. Most cases of this condition with variable expression occur sporadically, but there are some cases indicative of a strong genetic component apart from environmental factors. This is a report about another rare mother-child pair with bladder exstrophy. METHODS We present the clinical data of a familial case of bladder exstrophy with an affected mother and her equally affected male fetus. RESULTS Prenatal diagnosis of bladder exstrophy in the fetus was assessed by ultrasound at the 19th gestational week and was confirmed after termination of pregnancy at the 21st gestational week. CONCLUSION The present case may be additional evidence for an autosomal dominant inherited variant of this malformation complex with implication for counselling of affected patients.
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Affiliation(s)
- U G Froster
- Institute of Human Genetics, University of Leipzig, Leipzig, Germany.
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Affiliation(s)
- R L Lebowitz
- Department of Radiology, Children's Hospital, Boston, Harvard Medical School, Boston MA 02115, USA.
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Abstract
BACKGROUND/PURPOSE The embryology of bladder and cloacal exstrophy is a mystery. Reasons for this are the lack of human embryos showing these malformations as well as the scarcity of appropriate animal models. Here, the authors present cases of cloacal exstrophies found in chick embryos subsequent to the application of suramin and trypan blue. This animal model might facilitate insight into the embryology of cloacal exstrophy. METHODS Fertilized chicken eggs were incubated at 38 degrees C and 75% humidity. Embryos were treated in ovo on incubation day 3. The egg shell was windowed, and solutions of suramin (stage 13, 2 x 40 microL/0.2%) or trypan blue (stage 14, 2 x 80 microL/0.03%) were injected into the coelomic cavity. The window was closed, and the embryos were reincubated until examination on incubation day 8. Fifty embryos were treated in each group. RESULTS Among the surviving embryos, cloacal exstrophy was found in 2 cases in the suramin-treated group (2 of 29, 6.9%) and in 4 cases in the trypan blue-treated group (4 of 20, 20%). CONCLUSIONS Suramin and trypan blue can induce cloacal exstrophy in chick embryos. The authors now are modifying their experimental protocols to increase the incidence of this malformation. This model might facilitate studies on the morphogenesis of cloacal exstrophy.
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Affiliation(s)
- Jörg Männer
- Department of Embryology, Georg-August-University, Göttingen, Germany
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35
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Abstract
Bladder exstrophy is a very rare congenital malformation in which the anterior wall of the bladder is absent, and the posterior wall is exposed externally. Although sonographic findings of bladder exstrophy have been documented, we report a case presenting with a solid mass in the lower fetal abdomen with umbilical arteries running alongside the mass. The relationship between umbilical arteries and bladder exstrophy is a new sonographic finding which may be helpful in the prenatal diagnosis of this condition.
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Affiliation(s)
- E-H Lee
- Department of Diagnostic Radiology, Gangneung Asan Hospital, Gangneung, Gangwon-do, South Korea.
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El-Sherbiny MT, Hafez AT, Ghoneim MA. Complete repair of exstrophy: further experience with neonates and children after failed initial closure. J Urol 2002; 168:1692-4; discussion 1694. [PMID: 12352336 DOI: 10.1097/01.ju.0000027525.81696.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The surgical repair of bladder exstrophy remains challenging for the urologist. Recently, complete primary repair has been used in neonates. We present our experience with this approach in neonates and children after failed initial closure. MATERIALS AND METHODS Between November 1998 and November 2000, 17 boys and 2 girls with bladder exstrophy underwent complete repair. Complete primary repair was performed in the first 72 hours of life in 4 boys. Complete repair with osteotomy was at a mean age +/- SD of 23 +/- 21 months (range 1 to 74) in 15 patients including 7 with failed initial closure. The bladder and urethra were closed in continuity with epispadias repair by total penile disassembly. All patients were kept in spica cast for 3 weeks. Ureteral stents and suprapubic tube were removed 10 and 14 days after surgery, respectively. Ultrasound was performed before surgery and 3 months thereafter, and voiding cystourethrography was obtained 3 months postoperatively and then annually in all cases. RESULTS Complete closure resulted in hypospadias in 10 boys (59%). There was no major complication. Mean followup +/- SD was 17 +/- 8 months (range 5 to 33). Temporary suprapubic urinary leakage was noted initially in 10 cases (52%) but no patient had persistent fistula. Initial postoperative renal ultrasound revealed hydronephrosis in 11 renal units (29%). However, at last followup only 1 renal unit (2%) showed pelvicaliceal dilatation. Two patients (10%) had a febrile urinary tract infection and were treated conservatively. Reflux was noted in 24 renal units (63%) but did not require surgery. The 4 boys in whom the closure was performed at birth had regular voiding with 60 to 90-minute dry intervals and mean bladder capacity +/- SD was 85 +/- 35 cc. The 15 older children had a mean bladder capacity of 74 +/- 37 cc and 5 (33%) had regular voiding with 30 to 90-minute dry intervals. CONCLUSIONS Complete repair of exstrophy is feasible in neonates and older children including, those with failed initial closure with minimal morbidity. There is a short-term evidence of favorable outcome in newborns. Longitudinal followup is required to determine the future need of bladder neck reconstruction and augmentation in older patients.
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Abstract
OBJECTIVES To demonstrate that the bladder plate and bladder neck in classic bladder exstrophy are laying on smooth muscle fibers that extend laterally to the pubic bones. METHODS We compared a male fetus of 28 weeks' gestational age with classic bladder exstrophy with a normal fetus of the same age. The specimens were divided into two parts by a midsagittal section, from the bladder neck to the membranous urethra. Thin transverse slices were also obtained on one part, and longitudinal slices on the other part. RESULTS The smooth musculature of the bladder is normally differentiated cytologically and extends laterally to the bony structures of the pelvis. The musculature of the bladder neck and urethra are normally present compared with the control. CONCLUSIONS The results of this study demonstrate the musculoskeletal organization of the urogenital system in classic bladder exstrophy. They also indicate that these structures should be clearly individualized and repaired in the reconstruction of classic bladder exstrophy.
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Affiliation(s)
- Alain Wakim
- Department of Pediatric Surgery, Hôpital Saint Vincent de Paul, Paris, France
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Abstract
OBJECTIVES To describe the pelvic floor musculature and bony pelvic anatomy in a case of naturally occurring classic bladder exstrophy in a rhesus monkey, the first reported case in the animal population since 1832, and compare the results to exstrophy seen in human newborns. METHODS A 7-day-old male rhesus monkey with classic bladder exstrophy was examined by a pediatric urologist and primate veterinarian before being killed. A multidetector row computed tomography study with three-dimensional reconstruction was obtained, and a comparison computed tomography study of a 17-day-old male human with exstrophy was also reconstructed three dimensionally. The bony pelvis and pelvic floor muscular anatomy of both subjects were then examined and compared. RESULTS On gross examination, a similar appearance of classic bladder exstrophy in the rhesus monkey and human newborn were noted, including an open exposed bladder, associated penile epispadias, and widely separated pubic bones. The evaluation of the three-dimensional models showed a similar orientation of the bony pelvis in both the rhesus and the human newborn. The iliac wings were significantly rotated outward, and the sacroiliac joint was 10 degrees wider than that seen in normal children. The exstrophy pelvic floor in both the rhesus and the newborn was markedly flattened, with approximately 33% of the muscle located anterior to the rectum to support the pelvic structures (normal children have 50% of their levator ani anterior to the rectum). CONCLUSIONS By using advancements in imaging modalities, this study illustrated that naturally occurring classic bladder exstrophy in the human newborn and rhesus monkey were identical in both external appearance and internal anatomy.
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Affiliation(s)
- Andrew A Stec
- Department of Urology, Division of Pediatric Urology, Johns Hopkins School of Medicine, Baltimore, Maryland 21287-2101, USA
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Stec AA, Pannu HK, Tadros YE, Sponseller PD, Wakim A, Fishman EK, Gearhart JP. Evaluation of the bony pelvis in classic bladder exstrophy by using 3D-CT: further insights. Urology 2001; 58:1030-5. [PMID: 11744482 DOI: 10.1016/s0090-4295(01)01355-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To provide a complete look at the bony pelvis in children with classic bladder exstrophy: dimensions, orientation, and relationships. METHODS Three-dimensional computed tomography was used in 6 boys and 1 girl, 5 of whom underwent primary closure and 2 who underwent reclosure at 4 and 8 months. These exstrophy pelves (intrapelvic angles and osseous dimensions) were compared with 26 age and sex-matched controls. RESULTS The iliac wing angle was 11.4 degrees larger in the classic bladder exstrophy cases. The sacroiliac joint angle was 9.9 degrees more externally rotated in the exstrophy cases. The pelvis was rotated 14.7 degrees in the superoinferior plane in the exstrophy cases. The mean pubic diastasis was 4.2 cm (0.6 cm in controls). The inter-triradiate distance in the patients with classic bladder exstrophy averaged 6.0 cm (4.2 cm in controls). CONCLUSIONS These new findings provide a better understanding of the bony pelvis, especially its posterior portion, in patients with classic bladder exstrophy. The results of this study revealed the orientation of the sacroiliac joints to be more externally oriented than previously thought and the pelvis to be rotated inferiorly, a previously unknown observation. Both of these factors will be important in the planning of newer osteotomies and pelvic reconstruction.
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Affiliation(s)
- A A Stec
- Department of Urology, Division of Pediatric Urology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Wilcox DT, Chitty LS. Non-visualisations of the fetal bladder: aetiology and management. Prenat Diagn 2001; 21:977-83. [PMID: 11746152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Failure to detect a normally filled fetal bladder on ultrasound scanning can imply the presence of a serious urogenital abnormality. Detailed scanning may elicit the underlying pathology, but there may be complex anomalies present, the full extent of which often has to await the results of postnatal investigations. Management in a combined paediatric urology:fetal medicine clinic is recommended.
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Affiliation(s)
- D T Wilcox
- Department of Paediatric Urology, Guys' and Great Ormond Street Hospital, London, UK
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Stec AA, Pannu HK, Tadros YE, Sponseller PD, Fishman EK, Gearhart JP. Pelvic floor anatomy in classic bladder exstrophy using 3-dimensional computerized tomography: initial insights. J Urol 2001; 166:1444-9. [PMID: 11547108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
PURPOSE We present the pelvic floor anatomy of the major pelvic floor musculature in classic bladder exstrophy, including the levator ani, obturator internus and obturator externus. By improving our knowledge of pelvic floor anatomy we hope to understand better the relationship of the pelvic floor to the bony anatomy as well as the role of osteotomy in changing pelvic floor anatomy to enhance urinary control after surgery. MATERIALS AND METHODS 3-Dimensional computerized tomography was done in 6 boys and 1 girl, including 5 patients 2 days to 5 months old (mean age 7 months) undergoing primary closure and 2 who were 4 and 8 years old undergoing repeat closure. The pelvic floor musculature, including the levator ani, obturator internus and obturator externus, in these cases was compared to that in 26 age and sex matched controls. RESULTS The levator ani musculature encompasses a significantly wider area of 9.5 cm.2 in patients with classic bladder exstrophy than in controls. The anterior segment of the levator ani was shorter (1.2 cm.) and the posterior segment of the levator ani was longer (2.5 cm.) than in controls. The degree of divergence of the levator ani in classic exstrophy was significantly more outwardly rotated (38.8 degrees) than controls. In addition, the transverse diameter of the levator hiatus was 2-fold that in our control group and in that of published controls, while the length of the hiatus was 1.3-fold that in normal controls. There was also significant flattening, involving a 31.7 degree decrease in steepness between the right and left halves of the levator ani, of the puborectal sling in classic bladder exstrophy versus controls. Because of these findings, there is more anterior superior rotation in the pelvic floor in exstrophy cases. The obturator internus was more outwardly rotated (15.1 degrees) in exstrophy and the obturator externus also showed more outward rotation (16.9 degrees) than in controls. CONCLUSIONS This study provides better understanding of the pelvic floor anatomy in classic bladder exstrophy. Significant differences have been documented in the pelvic floor in classic bladder exstrophy cases and controls. Hopefully these differences may have a pivotal role in providing new insight into long-term issues, such as urinary and fecal incontinence, and pelvic organ prolapse, in classic bladder exstrophy.
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Affiliation(s)
- A A Stec
- Division of Pediatric Urology, Department of Urology, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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42
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Abstract
OBJECTIVE Reconstructive surgery of bladder exstrophy remains a challenge. By using CT of the pelvis, we suggest a new pre- and post-operative investigative procedure to define the AP diameter (APD) as a predictive criterion for continence in this anomaly. PATIENTS AND METHODS Three axial CT slices were selected in nine children with exstrophy who had undergone neonatal reconstructive surgery. The three levels selected were the first sacral plate, the mid acetabular plane and the superior pubic spine. We used combined slices to measure: APD = distance between the first sacral vertebra and the pubic symphysis. Pubic diastasis (PD). Three angles defined on the transverse plane of the first sacral vertebra--iliac wing angle, sacropubic angle and acetabular version. RESULTS In exstrophy, the angles demonstrate opening of the iliac wings and the pubic ramus, and acetabular retroversion compared to controls. Comparisons between controls, continent and incontinent patients reveal that in continent patients, APD increases with growth and seems to be a predictive criterion for continence, independent of diastasis of the pubic symphysis. CONCLUSIONS We believe that CT of the pelvis with measurements of the APD should be performed in all neonates with bladder exstrophy before reconstructive surgery and for better understanding of the malformation. The APD seems to be predictive and may be a major criterion for continence, independent of PD.
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Affiliation(s)
- A Ait-Ameur
- Department of Radiology, Hôpital St Vincent de Paul, 82 av Denfert Rochereau, 75674 Paris Cedex 14, France.
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Abstract
We report a rare case of covered cloacal exstrophy variant with a hemiphallus trapped within partially closed bladder halves. The persistence of the cloacal membrane until at least 18 weeks' gestation, confirmed by antenatal ultrasound scanning, is discordant with existing theories of embryogenesis of cloacal exstrophy. The clinical presentation highlights the need for careful assessment, before and during surgery, to obtain a complete understanding of the anatomic defect before gender assignment and appropriate reconstructive efforts. A multispecialty approach and antenatal counseling are important, especially when only one fetus of twins has major birth defects.
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Affiliation(s)
- Y Lakshmanan
- Department of Surgery, Division of Urology, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA
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Cromie WJ, Lee K, Houde K, Holmes L. Implications of prenatal ultrasound screening in the incidence of major genitourinary malformations. J Urol 2001; 165:1677-80. [PMID: 11342955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
PURPOSE During the last 3 decades infant mortality has decreased nearly 50%. While neonatal intensive care deserves much of the credit, the recent increase in prenatal ultrasound from 33% of pregnancies in 1980 to 78% in 1987 has improved early detection. We evaluate the impact of prenatal ultrasound on major genitourinary malformations. MATERIALS AND METHODS Data obtained from the Malformations Surveillance Program at Brigham and Women's Hospital between 1974 and 1994 tracked 163,431 pregnancies and termination rates of fetuses with spina bifida, bladder exstrophy, the prune belly syndrome and posterior urethral valves. RESULTS Hospital data revealed that pregnancy was electively terminated due to spina bifida in 65% of cases, posterior urethral valves in 46%, the prune belly syndrome in 31% and exstrophy in 25%. CONCLUSIONS Clearly, surveillance programs and improved accuracy of prenatal ultrasound have allowed early diagnosis of major genitourinary malformations. Many factors influence decision making in these affected fetal cases, including the financial and emotional impact of these major anomalies during lifetime. Future societal decisions and reduction in these anomalies may influence our training programs, manpower needs, medical facility requirements and character of our practices. These findings may have significant implications in the field of pediatric urology.
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Affiliation(s)
- W J Cromie
- Department of Surgery, Section of Urology and Department of Pediatrics, Section of Neonatology, University of Chicago, Chicago, Illinois, USA
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Abstract
Bilateral posterior iliac osteotomy is performed in most patients undergoing primary closure of an exstrophic bladder; the aims are to facilitate abdominal-wall closure, prevent postoperative wound dehiscene, and possibly, to achieve better urinary control in older age. A new technique, anterior pelvic osteotomy of the superior pubic ramus, seems to obtain tension-free symphysis approximation safely and quickly. We report our initial experience with this osteotomy. Five neonates, four males and one female from 1 to 4 days old, all underwent closure surgery for bladder exstrophy (BE) and subsequent bilateral osteotomy of the superior pubic ramus (SPRO). Postoperatively, Bryant's traction was applied. Tension-free, complete approximation of the symphysis and uncomplicated healing were achieved in all five cases without palsy of the obturator nerve or postoperative hemorrhage. Follow-up revealed partial rediastasis with a stable anterior pelvic ring. Tension-free closure and immobilization are important factors in both initial and subsequent closure of BE. Several osteotomy techniques are currently in use. SPRO presents numerous advantages, namely, ease and rapidity, minimal blood loss, and no requirement for an extra skin incision or need to turn the patient on the operating table. A certain degree of rediastasis with growth was subsequently observed: although undesirable, this complication is common to all osteotomy techniques. We believe that SPRO is a valid and uncomplicated method to facilitate BE closure.
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Affiliation(s)
- G Chiari
- Divisione di Chirurgia Pediatrica, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
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Abstract
A 15-day-old female presented with a healed omphalocele and a triangular musculoskeletal defect in the hypogastric area similar to the defect seen in classic bladder exstrophy. The bladder was normal on exploration. The defect was successfully closed using a bilateral anterior pubic ramotomy. Only ten cases of pseudoexstrophy have been reported in the world literature.
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Affiliation(s)
- I V Meisheri
- Department of Pediatric Surgery, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai 400 012, India
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47
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Abstract
BACKGROUND Classic bladder exstrophy is a developmental defect presenting at birth with a wide pubic separation and an exposed bladder; cloacal exstrophy involves, in addition, intestinal prolapse. Reconstruction requires several surgical procedures. The use of anterior iliac osteotomies in this process has not been reviewed in a large series. METHODS We reviewed the results of eighty-six anterior innominate osteotomies performed in conjunction with genitourinary repair of classic and cloacal bladder exstrophy in eighty-two patients. Clinical outcome measures were successful bladder closure, achievement of continence, and maintenance of a normal gait. Radiographs of the pelvis were reviewed, and the pubic intersymphyseal diastasis (a measure of the reduction in tension on the anterior closure) was measured preoperatively and at three time-points postoperatively. Children with classic exstrophy who had undergone osteotomy and bladder neck reconstruction but not bladder augmentation were divided into four groups on the basis of the degree of continence. In addition, children with classic exstrophy were stratified according to age at the time of the osteotomy. The mean postoperative percent reduction in the amount of the original diastasis was determined for all groups. RESULTS Children with classic exstrophy and those with cloacal exstrophy had correction of the diastasis after the osteotomy, with greater correction in those with classic exstrophy, presumably because of better bone quality. Daytime continence was achieved with anterior osteotomy and bladder neck reconstruction in 74% of the children for whom continence was a goal. However, no difference in the symphyseal diastasis or in the percentage of pubic reduction was detected among the four continence groups. Children who were older at the time of the osteotomy maintained better correction over time. Wound dehiscence or bladder prolapse occurred in 4% of the patients who had osteotomy and primary closure, and the only important complication of the osteotomies was transient palsy of the left femoral nerve in seven children. CONCLUSIONS Anterior innominate osteotomy is an effective part of reconstructive repair of bladder exstrophy. The primary goals of the osteotomy are to reduce the tension in the closed bladder and the lower abdominal wall and to promote continence by restoring the sling of the pelvic floor muscles. These goals can be achieved in the majority of patients.
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Affiliation(s)
- P D Sponseller
- Department of Orthopaedic Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
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Timor-Tritsch IE, Monteagudo A, Horan C, Stangel JJ. Dichorionic triplet pregnancy with the monoamniotic twin pair concordant for omphalocele and bladder exstrophy. Ultrasound Obstet Gynecol 2000; 16:669-671. [PMID: 11169378 DOI: 10.1046/j.1469-0705.2000.00281.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Abstract
Eight hemipelvises in ischiopagus tetrapus conjoined twins were assessed retrospectively to determine whether posterior iliac osteotomy is appropriate to reconstruct pelvic symmetry. Although clinical and radiological similarity exists with classic bladder exstrophy, axial and three-dimensional computed tomography showed the pelvic deformity to be very different. In classic bladder exstrophy, the deformity is one of shortening and external rotation of the anterior segment, and external rotation of the posterior segment. The deformity in the ischiopagus tetrapus pelvis is purely one of external rotation of the posterior segment. Posterior iliac osteotomy alone was therefore able to restore pelvic symmetry in seven of the eight hemipelvises, and prevented rediastasis of the symphysis pubis in all patients.
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Affiliation(s)
- M D Verrier
- Department of Orthopaedic Surgery, University of Cape Town, South Africa.
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Affiliation(s)
- A Ebert
- Department of Urology, Friedrich-Alexander-University, Erlangen-Nürnberg, Germany
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