Paediatric Imaging

Bladder exstrophy

a congenital condition, one of the anterior abdominal wall defects in which the bladder lies exposed on the lower abdominal surface. The incidence is about 1 per 10,000 live births. It lies between epispadia and cloacal exstrophy in terms of severity. This condition potentially can be diagnosed in utero but often is not as the lower part of the abdominal wall between the umbilicus and perineum is a difficult area to demonstrate in pregnancy due to surrounding bony structures including the lower limbs and pelvis. The diagnosis is instantly obvious post delivery, there is often associated epispadias. The pubic symphysis is always widened (Fig.1) with diastasis of the rectus muscles. Vertebral anomalies are sometimes associated. Surgical reconstruction of the bladder is often feasible and bladder augmentation or diversion procedures are sometimes necessary. Iliac osteotomies to approximate the pubic bones are often required. Vesicoureteric reflux occurs in most cases postoperatively.

Postnatal imaging is limited in the neonatal period to a plain radiograph to assess the pelvic bones. Postoperative cystography is sometimes required to assess both reflux and bladder emptying.

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Fig.1

Late image of an intravenous urography of a child with bladder exstrophy showing normal upper tracts and ureters.Note the wide symphysis.
Bladder exstrophy, Fig.1