Prenatal Diagnosis of Bladder and Cloacal Exstrophy and Related Conditions

Abstract

Bladder exstrophy (Barth et al., 1990; Bronshtein et al., 1993; Gearhart et al., 1995; Jaffe et al., 1990; Khandelwal et al., 1996; Messelink et al., 1994; Pinette et al., 1996) and its related cousin hypospadias (Sides et al., 1996), are among the most challenging entities that can be identified before birth with ultrasound. Hypospadias is the most common of these lesions, but is most difficult to diagnose. A series of six cases and two case reports of the prenatal diagnosis of hypospadias exist (Sides et al., 1996). Typically, the penis is short and it is often curved. The distal end of the phallus is widened forming a club shape. Since, color flow Doppler records flow movement, whether of blood or urine, color flow Doppler permits the visualization of urination, which is seen as an intermittent jet. Normally, jets of urine are seen coming from the tip of the penis but in hypospadias, the urine originates from a more proximal and inferior site than the tip of the penis. The penis has to be examined in a sagittal profile view for a decision as to the source if jet effect to be made with confidence.