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Extrophy of BLADDER

Bladder extrophy is a congenital malformation characterized by the absence of the lower abdominal wall and anterior bladder, leading to urinary leakage. It is associated with various congenital anomalies and requires both medical and surgical management, including reconstructive surgery and supportive nursing care. Successful outcomes depend on early intervention and comprehensive patient education.

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5 views24 pages

Extrophy of BLADDER

Bladder extrophy is a congenital malformation characterized by the absence of the lower abdominal wall and anterior bladder, leading to urinary leakage. It is associated with various congenital anomalies and requires both medical and surgical management, including reconstructive surgery and supportive nursing care. Successful outcomes depend on early intervention and comprehensive patient education.

Uploaded by

sriparnamondal0018
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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EXTROPHY OF

BLADDER

PRESENTED BY:
SRIPARNA MONDAL
B.SC. NURSING
5TH SEMESTER
GCON. ID & BG HOSPITA
INTRODUCTION

Classical Bladder Extrophy comes under the wide range of congenital malformati
lower urino-genital tract collectively known as Bladder-extrophy-epispadias-comp

Extrophy of bladder is usually associated with numbers of congenital anomalies r


urogenital tract , musculoskeletal system and sometimes GI system.

t is also termed as ‘Ectopia vesicae’.


DEFINITION
The term ‘Extrophy’ means –turned inside out. Extrophy of bladder is a congeni
malformation in which the lower portion of the abdominal wall and the anterior
of the bladder are missing , so that the bladder is everted through the opening
may found on the lower abdomen just above the symphasis pubis with continuo
passage of urine to the outside.
ANATOMICAL POSITION OF BLADDER
ANATOMY OF BLADDER
NORMAL CONDITION

Bladder
Extrophy
In girls
BONY ABNORMALITIES IN BLADDER EXTROPHY
ETIOLOGY

The most accepted theory regarding the etiology and pathogenesis of bladder
extrophy was proposed by Marshall & Muecke :
An abnormally large cloacal membrane causes a wedge effect and pr
The medial migration of the mesenchymal tissue. Hence, the lower abdominal w
Is not well-formed. A subsequent rupture of cloacal membrane results in herniati
leading to the clinical condition of bladder extrophy.
PATHOPHYSIOLOGY
• Abnormalities involving lower urinary tract, abdominal wall, bony pelvis, ge
pelvic floor and anus.
• The distorted anatomy of bony pelvis can be described by the term – ‘Open
configuration’.
• Pubic diastasis distance is increased.
• Anterior segments of bony pelvis are shorter.
• Both anterior and posterior segments of bony pelvis are externally rotated.
CLINICAL MANIFESTATION
• Constant urinary dribbling through the defect.
• Skin excoriation.
• Infection and ulceration of the bladder mucosa.
• The child may have ambiguous genitalia.
• Waddling unsteady gait.
• UTI.
• Growth failure.
DIAGNOSIS METHODS

• Cytoscopic examination.
• X-ray.
• USG.
• IVP.
• Urodynamic testing.
MANAGEMENT OF BLADDER EXTROPHY
A) MEDICAL MANAGEMENT :-
are given to prevent UTI in patients with bladder extrophy :

n,
, etc.
B) SURGICAL MANAGEMENT :-

Reconstructive surgery : Surgical closure of the bladder & complete correction


of the malfunction –
(1) MODERN STAGED REPAIR OF EXTROPHY (MS
(2) COMPLETE PRIMARY REPAIR OF EXTROPHY (

Osteotomy
C) NURSING MANAGEMENT :-
(1) Pre operative Supportive Nursing Care :

• Protection of bladder area from infections and trauma.


• Avoiding irritating clothing and linen over exposed bladder.
• Positioning the infant on back or side.
• Humidifying the exposed bladder by covering with wet gauze.
• Maintaining aseptic precautions, general hygiene, routine care.
(2) Post operative supportive nursing care :

• Close monitor child’s condition, Vital signs, features of infection.


• Monitor intake / output.
• Care of urinary catheter- it’s position, drainage, aseptic precautions.
• Instruction given to parents about necessary precautions for prevention
infection, dislodgement or leakage.
• Provide routine post operative care.
• Necessary information given to parents regarding home based care, follo
, signs of complications & their prevention.
• Nursing Diagnosis :
(1)Pre operative –

• Impaired body image related to extrophy of bladder as evidenced by baby


mother’s verbalization.
• Fluid volume deficit related to constant urine dribbling as evidenced by dr
skin, poor turgor pressure.
• Risk for infection related to exposed bladder.
(2) Post operative –

• Pain related to surgical incision as evidenced by child’s cry, mother’s


verbalization.
• Risk for bleeding from the surgical site related to surgery in bladder.
• Risk for impaired fluid balance related to surgery in bladder.
• Respiratory distress related to pain as evidenced by shallow, quick breath
• Risk for infection related to surgical incision.
PROGNOSIS
1) CONTINENCE

2) UPPER TRACT DAMAGE :


• Hydronephrosis or Upper tract dialation
• Recurrent UTI & Renal scarring

3) SEXUAL FUNCTION
COMPLICATIONS
• Wound dehiscence
• Bladder dehiscence
• Bladder prolapse
• Dysuria
• Wound infection
• Urethral obstruction
• Urethrocuteneous fistula
• Persistent incontinence, UTI, Bladder stones
• Osteotomy complications
PATIENT EDUCATION
• Engaging the child in a voiding programme
• Education about benefits of Clean intermitten catheterization (CIC)
• Importance of proper hygiene
• Importance of compliance of medication
SUMMARIZATION
CONCLUSION
A carefully planned surgical reconstruction for bladder extrophy can lead to
satisfactory long-term urinary continence in most patients. Factors contributi
to successful results include early bladder closure, pelvic osteotomy, adequa
bladder neck reconstruction with bladder neck suspension in girls, & a motiva
child and family.

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