What are the common causes of bladder wall thickening. How is bladder wall thickening diagnosed. What are the treatment options for bladder wall thickening. Can bladder wall thickening be prevented.

Understanding Bladder Anatomy and Function

The urinary bladder is a crucial component of the human body’s excretory system. Located in the pelvic cavity, this balloon-shaped organ serves as a temporary storage vessel for urine produced by the kidneys. With a capacity of approximately 2 cups (470 ml), the bladder plays a vital role in regulating urination.

When urine flows from the kidneys into the bladder, the muscular walls of the organ relax to accommodate the increasing volume. As the bladder fills, nerve signals are sent to the brain, creating the sensation of needing to urinate. During urination, the bladder muscles contract, pushing urine through the urethra and out of the body.

The Structure of the Bladder Wall

The bladder wall consists of several layers, each serving a specific purpose:

• Urothelium (transitional epithelium): The innermost layer that acts as a barrier between urine and underlying tissues
• Lamina propria: A layer of connective tissue beneath the urothelium
• Detrusor muscle: The thick muscular layer responsible for bladder contraction during urination
• Adventitia/serosa: The outermost layer that provides additional support and protection

Bladder Wall Thickening: An Overview

Bladder wall thickening is a condition characterized by an increase in the thickness of the bladder’s muscular wall. This thickening can occur due to various factors and may be indicative of underlying health issues. Understanding the causes, symptoms, and potential complications of bladder wall thickening is crucial for early detection and appropriate treatment.

How is bladder wall thickening detected?

Bladder wall thickening is typically detected through imaging studies such as ultrasound, CT scans, or MRI. These diagnostic tools allow healthcare providers to visualize the bladder’s structure and measure the thickness of its walls. In some cases, cystoscopy may be performed to directly examine the bladder’s interior and obtain tissue samples if necessary.

Common Causes of Bladder Wall Thickening

Several conditions can lead to the thickening of the bladder wall. Identifying the underlying cause is essential for determining the appropriate treatment approach. Here are some of the most common causes:

Urinary Tract Infections (UTIs)

UTIs are a frequent cause of bladder wall thickening, particularly when they become chronic or recurrent. The inflammation caused by bacterial infections can lead to the thickening of the bladder wall over time. Women are more susceptible to UTIs due to their shorter urethra, which allows bacteria easier access to the bladder.

Bladder Outlet Obstruction (BOO)

BOO occurs when there is a blockage at the base of the bladder, impeding the flow of urine. This condition can cause the bladder muscles to work harder, leading to wall thickening. Common causes of BOO include:

• Enlarged prostate (benign prostatic hyperplasia) in men
• Urethral strictures
• Bladder stones
• Tumors in the bladder or surrounding tissues

Neurogenic Bladder

Neurogenic bladder is a condition where nerve damage affects the bladder’s ability to function properly. This can lead to incomplete emptying, increased pressure within the bladder, and subsequent wall thickening. Conditions associated with neurogenic bladder include:

• Spinal cord injuries
• Multiple sclerosis
• Parkinson’s disease
• Diabetic neuropathy

Bladder Cancer

While not all cases of bladder wall thickening are indicative of cancer, it can be a sign of malignant tumors. Bladder cancer often begins in the urothelium and can cause localized or diffuse thickening of the bladder wall as it progresses.

Symptoms Associated with Bladder Wall Thickening

The symptoms of bladder wall thickening can vary depending on the underlying cause. However, many individuals experience changes in their urinary habits and may notice the following:

• Increased frequency of urination
• Urgency to urinate
• Difficulty initiating urination
• Weak or interrupted urine stream
• Incomplete bladder emptying
• Pain or discomfort in the lower abdomen or pelvic area
• Blood in the urine (hematuria)

It’s important to note that these symptoms can be associated with various bladder conditions, not just wall thickening. Consulting a healthcare provider for proper diagnosis is crucial.

Diagnostic Approaches for Bladder Wall Thickening

When bladder wall thickening is suspected, healthcare providers employ a combination of diagnostic tools to determine the cause and extent of the condition. The diagnostic process typically involves:

Medical History and Physical Examination

A thorough review of the patient’s medical history, including any urinary symptoms, previous bladder issues, and risk factors for bladder conditions, is conducted. A physical examination may also be performed to check for any visible signs of bladder or pelvic abnormalities.

Urinalysis and Urine Culture

These tests help identify the presence of infection, blood, or other abnormalities in the urine that may be contributing to bladder wall thickening.

Imaging Studies

Various imaging techniques can be used to visualize the bladder and measure wall thickness:

• Ultrasound: A non-invasive method that uses sound waves to create images of the bladder
• CT Urography: Provides detailed cross-sectional images of the entire urinary system
• MRI: Offers high-resolution images of the bladder and surrounding tissues

Cystoscopy

This procedure involves inserting a thin, flexible tube with a camera (cystoscope) into the urethra to examine the bladder’s interior. It allows for direct visualization of the bladder wall and can help identify abnormalities such as tumors or inflammation.

Biopsy

If a suspicious area is found during cystoscopy, a small tissue sample may be taken for further analysis to rule out cancer or other conditions.

Treatment Options for Bladder Wall Thickening

The treatment for bladder wall thickening depends on the underlying cause and severity of the condition. Here are some common approaches:

Treating Urinary Tract Infections

If a UTI is responsible for bladder wall thickening, antibiotics are typically prescribed to eliminate the infection. In cases of recurrent UTIs, long-term antibiotic prophylaxis may be recommended.

Addressing Bladder Outlet Obstruction

Treatment for BOO varies based on the cause:

• Enlarged prostate: Medications to shrink the prostate or relax the muscles around the urethra may be prescribed. In severe cases, surgical interventions such as transurethral resection of the prostate (TURP) may be necessary.
• Urethral strictures: Dilation procedures or surgical repair of the urethra may be performed.
• Bladder stones: Removal through cystoscopy or other minimally invasive techniques is typically recommended.

Managing Neurogenic Bladder

Treatment for neurogenic bladder focuses on improving bladder function and preventing complications. Options may include:

• Clean intermittent catheterization
• Medications to relax the bladder muscles or increase bladder capacity
• Botulinum toxin injections into the bladder wall
• Neuromodulation techniques

Treating Bladder Cancer

If bladder cancer is diagnosed, treatment will depend on the stage and grade of the tumor. Options may include:

• Transurethral resection of bladder tumor (TURBT)
• Intravesical chemotherapy or immunotherapy
• Radical cystectomy (removal of the entire bladder) in advanced cases
• Radiation therapy and systemic chemotherapy for metastatic disease

Preventing Bladder Wall Thickening

While not all cases of bladder wall thickening can be prevented, certain lifestyle changes and preventive measures can help reduce the risk:

Maintaining Good Urinary Hygiene

Proper hygiene practices can help prevent UTIs, which can contribute to bladder wall thickening. This includes:

• Wiping from front to back after using the toilet
• Urinating before and after sexual activity
• Avoiding holding urine for extended periods

Staying Hydrated

Drinking adequate amounts of water helps flush bacteria from the urinary system and may reduce the risk of UTIs and bladder irritation.

Quitting Smoking

Smoking is a significant risk factor for bladder cancer and can contribute to bladder wall thickening. Quitting smoking can help reduce this risk.

Regular Check-ups

Routine medical check-ups, especially for individuals at higher risk of bladder conditions, can help detect and address issues early before they lead to significant bladder wall thickening.

Long-term Outlook and Complications

The prognosis for individuals with bladder wall thickening varies depending on the underlying cause and the effectiveness of treatment. In many cases, addressing the root cause can lead to improvement or resolution of the condition. However, some potential complications may arise if left untreated:

Chronic Bladder Dysfunction

Persistent bladder wall thickening can lead to long-term changes in bladder function, including reduced bladder capacity and decreased elasticity. This may result in ongoing urinary symptoms and a decreased quality of life.

Increased Risk of Infections

A thickened bladder wall may be more susceptible to recurrent infections, particularly if it leads to incomplete bladder emptying.

Upper Urinary Tract Damage

In severe cases, prolonged bladder wall thickening and associated conditions can lead to reflux of urine into the ureters and kidneys, potentially causing damage to the upper urinary tract.

Bladder Cancer Progression

If bladder wall thickening is due to cancer and left untreated, it can progress to more advanced stages, making treatment more challenging and potentially impacting survival rates.

Regular follow-up with healthcare providers and adherence to recommended treatment plans are essential for managing bladder wall thickening and preventing potential complications. By staying vigilant and addressing any urinary symptoms promptly, individuals can work towards maintaining optimal bladder health and overall well-being.

Bladder Wall Thickening: Causes and Treatment

Introduction

Your urinary bladder is a balloon-shaped organ that stores urine from the kidneys until it’s released through the urethra. The bladder is located in the pelvic cavity between the pelvic bones. It can hold around 2 cups of urine.

When the bladder is filling with urine, the muscles in the bladder wall relax. When it’s time to urinate, the bladder wall muscles tighten to help push urine out through the urethra.

A thickening of the bladder wall can be a sign of several medical conditions. It’s usually accompanied by other symptoms, too. Many of these conditions are easily treatable with an early diagnosis.

It’s important to report any changes in your urinary habits to your doctor. Bladder infections, for example, can lead to kidney infections. These can be quite serious if not treated early.

The muscular wall of your bladder tends to grow thicker if it has to work harder to urinate. It can also thicken if it becomes irritated and inflamed. Scarring of the bladder wall may also cause it to thicken.

Common causes of bladder wall thickening include:

Inflammation due to urinary tract infection (UTI)

A UTI is often the result of bacteria entering the urethra and then the bladder. These infections are more common among females than males.

UTIs are often associated with sexual intercourse, but a woman who isn’t sexually active can also develop a bladder infection. This is simply because of the amount of bacteria in and around the vagina.

One of the major responses to a UTI is inflammation of the bladder wall, a condition known as cystitis. Prolonged inflammation can lead to thickening of the wall. Some other causes of cystitis include inflammation triggered by cancer treatments, like radiation and chemotherapy, or prolonged use of a catheter.

Noncancerous tissue growths

Abnormal tissue growth in the bladder wall causes tumors to grow and the wall to thicken. Noncancerous (benign) tumors include papillomas. For some cases, viruses may be the cause of these growths.

Other benign bladder tumors include leiomyomas, but these are rare. They result from an overgrowth of smooth muscle cells in the bladder wall.

Fibromas are another benign bladder tumor. Abnormal growth of fibrous connective tissue in the bladder wall causes these.

Cancer

Cancerous (malignant) tumors tend to form first in the innermost lining of the bladder wall. This lining is known as the transitional epithelium.

The abnormal growth of cells in the bladder wall may be related to smoking tobacco or exposure to chemicals. Chronic irritation of the bladder wall or previous radiation exposure can also be the culprit.

Hemorrhagic cystitis

Sometimes irritation and inflammation of the bladder wall causes bleeding from the bladder lining. This is considered hemorrhagic cystitis. Causes may include:

• radiation therapy
• chemotherapy
• an infection
• exposure to certain chemicals, such as insecticides or dyes

Amyloidosis

Amyloid is a type of abnormal protein that’s made in your bone marrow. Amyloidosis is the buildup of amyloid in an organ. The bladder is one of several organs that can be vulnerable to this disease, but it’s not common.

End stage renal disease can trigger the abnormal growth of amyloid when dialysis doesn’t filter out amyloid that may be present. Autoimmune inflammatory diseases, such as rheumatoid arthritis, can also trigger amyloidosis, as well as other conditions. There’s also an inherited version called familial amyloidosis.

Bladder outlet obstruction

Bladder outlet obstruction (BOO) is a blockage at the base of the bladder where it empties into the urethra. For men, an enlarged prostate or prostate cancer can result in BOO. Other causes of BOO for men and women include:

• bladder stones
• tumors
• scar tissue in the urethra

Symptoms of bladder wall thickening usually relate to changes in your urinary habits. You may urinate more frequently, or you may notice that it feels different when you relieve yourself. You may also notice changes in the urine itself.

Underlying causes, such as infections or tumors, can lead to some of the following symptoms:

Fever

Cystitis may cause a low-grade fever. A fever is a symptom of many conditions. But if a fever develops at the same time as bladder-related symptoms, see your doctor right away.

Pain when urinating

Painful urination is a symptom of many conditions as well, ranging from sexually transmitted diseases (STDs) to bladder cancer. A bladder or kidney infection can also cause a burning sensation when you’re urinating. This is one of the surest signs that you should seek medical treatment soon.

Urgency or difficulty urinating

A bladder disorder can make it difficult to fully empty your bladder. This can cause frequent urination, feeling like you always have to urinate, or both.

When the bladder wall thickens, the bladder may not be able to hold as much urine as it normally does. This can create those urgent feelings of having to urinate more frequently. BOO can also make it harder to urinate.

Cloudy urine or blood in urine

You may also see a small amount of blood in your urine. Sometimes this occurs from something as harmless as a strenuous workout. It could also be a sign of cystitis, bladder cancer, or another urinary tract problem.

Often, blood in urine can only be seen under a microscope. If you can see blood in your urine yourself or notice your urine turning cloudy, see your doctor, even if you have no other symptoms yet. It can be a sign of several potentially serious conditions. It’s best to get an early diagnosis sooner rather than later.

Foul-smelling urine

Foul-smelling urine or urine with a very strong smell could simply be related to food or beverages you recently consumed. However, it may be a sign of infection. Once a bladder infection is effectively treated, the related foul smell should disappear.

The underlying causes of a thickened bladder wall can differ between men and women.

BOO is more common among men, because it’s often linked to prostate problems. An enlarged prostate forces the bladder to work harder to empty itself of urine. This in turn causes the bladder wall to thicken. Prostate treatment can help reduce the burden on the bladder.

UTIs are more common among women. Thorough treatment can ease the strain on the bladder and allow thickened bladder walls to return to normal.

If you notice symptoms of bladder wall thickening or any symptoms related to your urinary tract system, see your doctor.

They’ll likely have you undergo several tests, such as a urinalysis. For this test, a sample of your urine is checked for signs of infection, blood cells, or abnormal protein levels. If your doctor suspects bladder cancer, they’ll check for cancer cells, too.

If cancer is a possibility, a cystoscopy may also be performed. During this procedure, a thin, flexible scope is guided up the urethra to check the lining of your urethra and bladder. A cystoscopy can also evaluate recurrent infections in the urinary tract.

In addition, a woman may undergo a pelvic exam to help diagnose an infection or other disorder.

Treating a thickened bladder wall means treating the underlying condition that caused the change in the wall.

For example, UTI treatment usually involves a course of antibiotic therapy. To prevent UTIs, practice good hygiene. Wipe front to back to reduce the risk of germs from the rectum reaching the urethra.

Surgery can remove noncancerous tumors that are causing you symptoms. The tumors usually won’t recur.

Cancerous growths can sometimes be removed with surgery, too. Additional cancer treatments, such as chemotherapy or radiation, may also be necessary.

Prostate treatment is a somewhat controversial subject. Prostate surgery can sometimes lead to incontinence or erectile dysfunction. If prostate symptoms are minor, your doctor may recommend a watch-and-wait approach to monitor your prostate regularly. Prostate cancer is often a slow-growing cancer. This means aggressive treatment isn’t always best.

If excess bladder emptying due to urge incontinence is a problem, your doctor may recommend anticholinergic drugs. These medications relax the detrusor muscle of the bladder.

If urinary retention is occurring due to BOO, your doctor may prescribe medication, such as tamsulosin, to help your urine flow be stronger.

A range of conditions can trigger bladder wall thickening. If you suspect that you have a condition causing you bladder problems, see your doctor, even if it just seems like a minor annoyance at first. Doing so will prevent your symptoms from worsening. Some bladder conditions can lead to life-threatening kidney problems.

Early treatment can prevent long-term harm and provide fast relief for uncomfortable symptoms.

Bladder Wall Thickening: Causes and Treatment

Introduction

Your urinary bladder is a balloon-shaped organ that stores urine from the kidneys until it’s released through the urethra. The bladder is located in the pelvic cavity between the pelvic bones. It can hold around 2 cups of urine.

When the bladder is filling with urine, the muscles in the bladder wall relax. When it’s time to urinate, the bladder wall muscles tighten to help push urine out through the urethra.

A thickening of the bladder wall can be a sign of several medical conditions. It’s usually accompanied by other symptoms, too. Many of these conditions are easily treatable with an early diagnosis.

It’s important to report any changes in your urinary habits to your doctor. Bladder infections, for example, can lead to kidney infections. These can be quite serious if not treated early.

The muscular wall of your bladder tends to grow thicker if it has to work harder to urinate. It can also thicken if it becomes irritated and inflamed. Scarring of the bladder wall may also cause it to thicken.

Common causes of bladder wall thickening include:

Inflammation due to urinary tract infection (UTI)

A UTI is often the result of bacteria entering the urethra and then the bladder. These infections are more common among females than males.

UTIs are often associated with sexual intercourse, but a woman who isn’t sexually active can also develop a bladder infection. This is simply because of the amount of bacteria in and around the vagina.

One of the major responses to a UTI is inflammation of the bladder wall, a condition known as cystitis. Prolonged inflammation can lead to thickening of the wall. Some other causes of cystitis include inflammation triggered by cancer treatments, like radiation and chemotherapy, or prolonged use of a catheter.

Noncancerous tissue growths

Abnormal tissue growth in the bladder wall causes tumors to grow and the wall to thicken. Noncancerous (benign) tumors include papillomas. For some cases, viruses may be the cause of these growths.

Other benign bladder tumors include leiomyomas, but these are rare. They result from an overgrowth of smooth muscle cells in the bladder wall.

Fibromas are another benign bladder tumor. Abnormal growth of fibrous connective tissue in the bladder wall causes these.

Cancer

Cancerous (malignant) tumors tend to form first in the innermost lining of the bladder wall. This lining is known as the transitional epithelium.

The abnormal growth of cells in the bladder wall may be related to smoking tobacco or exposure to chemicals. Chronic irritation of the bladder wall or previous radiation exposure can also be the culprit.

Hemorrhagic cystitis

Sometimes irritation and inflammation of the bladder wall causes bleeding from the bladder lining. This is considered hemorrhagic cystitis. Causes may include:

• radiation therapy
• chemotherapy
• an infection
• exposure to certain chemicals, such as insecticides or dyes

Amyloidosis

Amyloid is a type of abnormal protein that’s made in your bone marrow. Amyloidosis is the buildup of amyloid in an organ. The bladder is one of several organs that can be vulnerable to this disease, but it’s not common.

End stage renal disease can trigger the abnormal growth of amyloid when dialysis doesn’t filter out amyloid that may be present. Autoimmune inflammatory diseases, such as rheumatoid arthritis, can also trigger amyloidosis, as well as other conditions. There’s also an inherited version called familial amyloidosis.

Bladder outlet obstruction

Bladder outlet obstruction (BOO) is a blockage at the base of the bladder where it empties into the urethra. For men, an enlarged prostate or prostate cancer can result in BOO. Other causes of BOO for men and women include:

• bladder stones
• tumors
• scar tissue in the urethra

Symptoms of bladder wall thickening usually relate to changes in your urinary habits. You may urinate more frequently, or you may notice that it feels different when you relieve yourself. You may also notice changes in the urine itself.

Underlying causes, such as infections or tumors, can lead to some of the following symptoms:

Fever

Cystitis may cause a low-grade fever. A fever is a symptom of many conditions. But if a fever develops at the same time as bladder-related symptoms, see your doctor right away.

Pain when urinating

Painful urination is a symptom of many conditions as well, ranging from sexually transmitted diseases (STDs) to bladder cancer. A bladder or kidney infection can also cause a burning sensation when you’re urinating. This is one of the surest signs that you should seek medical treatment soon.

Urgency or difficulty urinating

A bladder disorder can make it difficult to fully empty your bladder. This can cause frequent urination, feeling like you always have to urinate, or both.

When the bladder wall thickens, the bladder may not be able to hold as much urine as it normally does. This can create those urgent feelings of having to urinate more frequently. BOO can also make it harder to urinate.

Cloudy urine or blood in urine

You may also see a small amount of blood in your urine. Sometimes this occurs from something as harmless as a strenuous workout. It could also be a sign of cystitis, bladder cancer, or another urinary tract problem.

Often, blood in urine can only be seen under a microscope. If you can see blood in your urine yourself or notice your urine turning cloudy, see your doctor, even if you have no other symptoms yet. It can be a sign of several potentially serious conditions. It’s best to get an early diagnosis sooner rather than later.

Foul-smelling urine

Foul-smelling urine or urine with a very strong smell could simply be related to food or beverages you recently consumed. However, it may be a sign of infection. Once a bladder infection is effectively treated, the related foul smell should disappear.

The underlying causes of a thickened bladder wall can differ between men and women.

BOO is more common among men, because it’s often linked to prostate problems. An enlarged prostate forces the bladder to work harder to empty itself of urine. This in turn causes the bladder wall to thicken. Prostate treatment can help reduce the burden on the bladder.

UTIs are more common among women. Thorough treatment can ease the strain on the bladder and allow thickened bladder walls to return to normal.

If you notice symptoms of bladder wall thickening or any symptoms related to your urinary tract system, see your doctor.

They’ll likely have you undergo several tests, such as a urinalysis. For this test, a sample of your urine is checked for signs of infection, blood cells, or abnormal protein levels. If your doctor suspects bladder cancer, they’ll check for cancer cells, too.

If cancer is a possibility, a cystoscopy may also be performed. During this procedure, a thin, flexible scope is guided up the urethra to check the lining of your urethra and bladder. A cystoscopy can also evaluate recurrent infections in the urinary tract.

In addition, a woman may undergo a pelvic exam to help diagnose an infection or other disorder.

Treating a thickened bladder wall means treating the underlying condition that caused the change in the wall.

For example, UTI treatment usually involves a course of antibiotic therapy. To prevent UTIs, practice good hygiene. Wipe front to back to reduce the risk of germs from the rectum reaching the urethra.

Surgery can remove noncancerous tumors that are causing you symptoms. The tumors usually won’t recur.

Cancerous growths can sometimes be removed with surgery, too. Additional cancer treatments, such as chemotherapy or radiation, may also be necessary.

Prostate treatment is a somewhat controversial subject. Prostate surgery can sometimes lead to incontinence or erectile dysfunction. If prostate symptoms are minor, your doctor may recommend a watch-and-wait approach to monitor your prostate regularly. Prostate cancer is often a slow-growing cancer. This means aggressive treatment isn’t always best.

If excess bladder emptying due to urge incontinence is a problem, your doctor may recommend anticholinergic drugs. These medications relax the detrusor muscle of the bladder.

If urinary retention is occurring due to BOO, your doctor may prescribe medication, such as tamsulosin, to help your urine flow be stronger.

A range of conditions can trigger bladder wall thickening. If you suspect that you have a condition causing you bladder problems, see your doctor, even if it just seems like a minor annoyance at first. Doing so will prevent your symptoms from worsening. Some bladder conditions can lead to life-threatening kidney problems.

Early treatment can prevent long-term harm and provide fast relief for uncomfortable symptoms.

Bladder exstrophy in children – treatment, diagnosis, symptoms and causes of the disease

Bladder exstrophy

What is bladder exstrophy?

Bladder exstrophy is a congenital anomaly of the bladder, vulva and pelvis. The bladder does not have a normal spherical shape, but is open in front and turned inside out in the lower abdomen – with the mucous membrane outward. The pelvic bones do not form a closed ring, since the pubic (pubic) bones are separated to the sides and between them there is a bladder platform. The navel is missing. Boys always have epispadias – a cleft of the anterior wall of the urethra with shortening and splitting in front of the penis. In girls, the clitoris is split into 2 halves, the vagina is displaced anteriorly, and there is no anterior commissure of the labia. All children have total urinary incontinence.

How common is bladder exstrophy?

The frequency of the anomaly is approximately 1 in 35,000 newborns. This anomaly occurs 3 times more often in boys than in girls. The probability of having a second child with exstrophy in one family is no more than 1%. The genetic basis of exstrophy is under study. The rarity of the pathology does not allow a large number of doctors to have experience in treatment. Therefore, exstrophy is successfully treated only by individual specialists.

What problems are associated with open bladder mucosa?

There are usually few such problems. To prevent the development of polyps on the urinary site due to mechanical irritation with diapers, it is covered with pre-perforated cling film (pierce many holes with a needle) and treated with antiseptics.

How is exstrophy treated and what is the key to success?

Exstrophy is a complex disease with many personal characteristics and problems. Surgical treatment. To achieve the optimal result, you should consult an exstrophy surgeon who is proficient in all methods and has significant experience in successful reconstructions. The team of doctors must have an experienced orthopedic surgeon to perform pelvic plasty and eliminate the gap between the pubic (pubic) bones. The surgeon and his team must guide the child for many years, conducting staged surgical treatment and timely preventing complications, in particular, impaired renal function. Physicians must be available for communication.

What is the treatment and operation for most patients with bladder exstrophy?

Treatment of exstrophy in stages. The first stage of the primary closure of the bladder is performed in 1-3 months. Then treatment is carried out aimed at increasing the bladder. The result of the main (second) stage depends on the capacity of the bladder – the creation of a urinary retention mechanism – the neck of the bladder and the urethral sphincter. Preferably – at the age of 4-6 years. When performing plastic surgery of the bladder neck in children aged 1-3 years, the bladder may stop its development.

Ureter transplantation is usually required before cervical plasty to eliminate vesicoureteral reflux. Approximately one third of children undergo pelvic plasty surgery – elimination of the interpubic gap. All children are shown aesthetic plastic surgery of the anterior abdominal wall, the creation of the navel. In boys, usually at the age of 1-3 years, the reconstruction of the penis – phalloplasty. In girls – plastic surgery of the external genital organs.

How often is a pelvic plasty required for exstrophy of the bladder. How important is it to combine it with the closure of the bladder?

Pelvic plasty should be performed when there is a large interpubic gap and to improve appearance. This is 30-40% of children with exstrophy and 10% of children with epispadias. Stabilization of the gait is achieved with pelvic plasty in children with an interpubic gap of more than 6 cm. According to recent data, the elimination of the interpubic gap does not affect the results of treatment of urinary incontinence and pelvic organ prolapse in girls. Osteotomy with convergence of the pubic bones can be performed separately from the closure of the bladder or together.

Is it possible to eliminate the interpubic gap without osteotomy?

According to the literature and practical experience, all attempts to eliminate the interpubic gap without osteotomy (in children older than 5 days of life) did not lead to positive results and gave many complications. Only the intersection of the iliac bones (osteotomy) allows you to reduce the pubic bones. Consolidation (fusion) in the areas of osteotomy occurs within 1-2 months, depending on age.

What happens if the bladder has not grown by the age of 5-6?

In some children, the bladder does not grow and microcystis is formed – a scarred bladder of small volume. This is due to the small size and pronounced polyposis changes already at birth or the early creation of a urinary retention mechanism. In such cases, an augmentation operation is performed – an increase in the capacity of the bladder through the use of a section of the intestine.

In which foreign countries and clinics is exstrophy treated?

Exstrophy is treated by surgeons in different countries. In Europe and the USA, exstrophy is treated by specialists working in multidisciplinary clinics. And this is justified, since a team of specialists is needed to achieve results and educate parents in all the nuances of dealing with difficult patients. When treating in small private clinics, for example, in Israel, Serbia, etc., operations are performed by one surgeon, pelvic bones are not reconstructed, and the length of stay in the hospital is drastically reduced. All this saves money, but savings often turn into complications and unnecessary operations.

What are the risks of treatment abroad?

A common danger of treating exstrophy abroad is the impossibility of direct contact with operating physicians after returning home. And there are many problems on which one has to consult – almost the entire list of urological diseases of childhood.

Bladder infections, acute pyelonephritis, urinary calculi, fistulas, vesicoureteral reflux and megaureter, non-developing bladder, pelvic organ prolapse in girls and short penis in boys, inability to pass a catheter through catheter channels, complications after urinary augmentation bladder, urinary retention, etc. Where the child lives, as a rule, there are no specialists ready to resolve issues of postoperative complications in patients operated on abroad.

Experience in the treatment of exstrophy in the RCCH. How successful is he?

Improvements in the treatment of exstrophy and in-house developments have taken our results to a new level. Through the study of the experience of different surgical schools, solutions were found that allowed us to propose a new approach to reconstructions and achieve urinary continence and spontaneous urination without intermittent bladder catheterization. At the end of treatment, all children retain urine and more than 70% of children can urinate on their own.

How important is it to ensure that the initial closure is successful the first time, and where should it be carried out?

Primary closure of the bladder is important to do well the first time. This increases the chances of achieving retention later on. Closure does not have to be performed after birth, the main thing is that it is performed by a specialist who has extensive positive experience in such operations. Over the past 8 years, we have successfully performed primary closure on over 40 exstrophy patients ranging in age from 1 month to 15 years.

Primary bladder closure: when and how?

Primary bladder closure plays a huge role in the multi-stage management of exstrophy. Parents should be aware of several important principles that especially affect the outcome.

Primary bladder closure immediately after birth has a 20 to 80% risk of complications. Complications in newborns are associated with a serious condition, hospital infections, lack of immunity, attempts to close the pubic ossicles, small size of the urinary plate, a long stay in the hospital (more than 30 days), etc. In addition, the child is in intensive care for several days, then on traction, with urinary drainage in the bladder and ureters, which contributes to the development of infection, makes care difficult, interferes with contact with the mother and breastfeeding.

It is believed that the contraction of the ossicles in newborns improves the results of closure. However, in practice, the number of complications after reduction in the first days of life only increases. Osteotomy and reduction of the pubic ossicles in newborns dramatically aggravate the child’s condition, delaying recovery and increasing the risk of infections. Subsequently, despite the reduction of the pubic ossicles and even the osteotomy, they again diverge up to 5-7 cm, which devalues ​​the efforts expended.

The best results of primary bladder closure are achieved between 1 and 3 months of age. Closure performed at 6-14 months may be accompanied by underdevelopment of the bladder. Proper care of the urinary plate after birth is also important for the outcome. A month after birth, the child fully recovers after childbirth, a close relationship with the mother is established, breastfeeding gives the child the necessary immunity, the intestines are populated with normal microflora.

Bladder closure surgeries performed at 1-3 months of age, in my experience, usually do not require an osteotomy and give excellent results. Healing occurs within 10-12 days, after which the child can be discharged home, not having time to get a nosocomial infection and related complications.

Osteotomy during closure is only needed in 10-15% of children with cloacal exstrophy or very large urinary plate (> 5 cm in diameter). In patients with wide pubic bone dehiscence, osteotomy, as well as penile plastic surgery, can be performed at an older age, when the child is already cured of urinary incontinence. And the results of phalloplasty in the absence of incontinence can be even better than in boys 1-2 years old.

In children aged 1 month with a small vesical plate (up to 3 cm) – in order to achieve a better result after birth or at the age of 1-2 months, it is worth injecting the bladder with Botox (Lantox or equivalent) and performing the operation after 4 months. During this time, the transverse size of the vesical plate increases by about 1.5 times, which is enough to achieve a good treatment result.

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Bladder exstrophy – treatment in Israel, reviews

Essence of disease

Bladder exstrophy is a rare congenital anomaly in which the bladder does not develop inside the fetus, but outside. In this case, the organ does not have its normal spherical shape, but is open in front and turned inside out by the mucous membrane. With this development, the bladder cannot function normally and urine is not kept inside, but flows out.

Bladder exstrophy entails various disorders, including defects in the genital organs and pelvic bones, as well as the intestinal tract.

Bladder exstrophy in the fetus can be seen during a routine ultrasound. However, this is not always the case, and if a child is born with this malformation, surgery is necessary.

Prevalence and risk factors

This pathology occurs with a frequency of approximately 1:35,000, in boys 3 times more often than in girls. Bladder exstrophy is considered a fairly rare anomaly, and its genetic and environmental causes are still being studied.

Risk factors include:

• Family history (for example, if the child’s parents or siblings had bladder exstrophy). Also, this defect is more likely to occur in firstborns
• Race – more common in Caucasians
• Use of reproductive technologies such as IVF

Symptoms

Bladder exstrophy is usually one of the manifestations of the exstrophy-epispadias complex (CEE).

The complex can have varying degrees of severity and manifest itself with one or more symptoms:

• Epispadias – underdevelopment of the urethra
• Bladder exstrophy
• Cloacal exstrophy is the most serious disorder. In this case, the bladder, rectum, and genitals do not separate completely as the fetus develops. As a result, these organs, as well as the pelvic bones, may be malformed
• Kidney disease
• Developmental disorders of the spine
• Spina bifida (spina bifida)

Diagnostics

Bladder exstrophy is usually detected during a routine ultrasound examination. The defect is also visible on MRI images.

Treatment of bladder exstrophy

This defect is eliminated during reconstructive surgery shortly after the birth of the child. The operation is carried out with several goals:

– Provide adequate bladder capacity

– Ensure the normal functioning of the bladder, including urinary retention

– Restore the appearance and functionality of the external genitalia

– Preserve kidney function

Forecast

Without surgical treatment, children with bladder exstrophy will have impaired urinary and sexual function, and an increased risk of bladder cancer.