Bladder Exstrophy for the General Urologist

New Discoveries and Modern Management
  • John P. Gearhart
  • Fernando A. Ferrer
Part of the Current Clinical Urology book series (CCU)


In this chapter, modern techniques for managing the newborn with classic bladder exstrophy are discussed. Management is based on the author’s experience and on data from more than 700 patients with the bladder exstrophy-epispadias-cloacal exstrophy spectrum seen at our institution. In addition, new basic science discoveries of interest to both the general and the pediatric urologist will be discussed. The primary objectives of modern surgical management of classic bladder exstrophy are as follows: (1) to create a secure abdominal closure, (2) to reconstruct a functional and cosmetically acceptable penis in the male and to reconstruct female external genitalia in the female, and (3) to preserve urinary continence, renal function, and volitional voiding. Currently, these objectives can best be achieved with newborn primary bladder and posterior urethral closure and early epispadias repair. Reconstruction of the bladder neck is undertaken when the bladder reaches an appropriate volume for an outlet procedure and the child is ready to participate in a postoperative voiding program. In this chapter, we will limit our discussion to the early management and initial primary closure of these infants.


Bladder Neck Pelvic Osteotomy Bladder Exstrophy Urethral Plate Abdominal Wall Closure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Lattimer JK, Smith MJK. (1966) Exstrophy closure: a follow up on 70 cases. J Urol 95: 356.PubMedGoogle Scholar
  2. 2.
    Lancaster PAL. (1987) Epidemiology of bladder exstrophy: a communication from the International clearinghouse for birth defects monitoring systems. Teratology 36: 221.CrossRefGoogle Scholar
  3. 3.
    Shapiro E, Lepor H, Jeffs RD. (1984) The inheritance of classical bladder exstrophy. J Urol 132: 308.PubMedGoogle Scholar
  4. 4.
    Gearhart J et al Classic and cloacal exstrophy associated with invitro pregnancy: start of a trend? submitted.Google Scholar
  5. 5.
    Muecke EC. (1964) The role of the cloacal membrane in exstrophy: the first successful experimental study. J Urol 92: 659.PubMedGoogle Scholar
  6. 6.
    Ambros SS, O’Brien DP. (1974) Surgical embryology of the exstrophy-epispadias complex. Surg Clin North Am 54: 1379.Google Scholar
  7. 7.
    Marshall VF, Muecke C. (1968) Congenital abnormalities of the bladder. In: Handbuch de Urologie, New York: Springer-Verlag, p. 165.Google Scholar
  8. 8.
    Sponseller PD, Bisson LJ, Gearhart JP, et al. (1995) The anatomy of the pelvis in the exstrophy complex. J Bone Joint Surg 77: 177.PubMedGoogle Scholar
  9. 9.
    Stec AA, Pannu HK, Tadros, YE (2001) Evaluation of the bony pelvis in classic bladder exstrophy by using 3-D CT. Urology 58: 1030.PubMedCrossRefGoogle Scholar
  10. 10.
    Stec AA, Pannu HK, Tadros YE, et al. (2001) Pelvic floor anatomy in classic bladder exstrophy using 3-dimensional computerized tomography: initial insights. J Urol 166 (4): 1444–1449.PubMedCrossRefGoogle Scholar
  11. 11.
    Connely JP, Peppas DS, Jeffs RD, et al. (1995) Prevalence in repair of inguinal hernia in children with bladder exstrophy. J Urol 154: 1900.CrossRefGoogle Scholar
  12. 12.
    Silver RI, Yang A, Ben-Chaim J et al. (1997) Penile length in adulthood after exstrophy reconstruction. J Urol 158: 999.Google Scholar
  13. 13.
    Gearhart JP, Ben-Chaim J, Jeffs RD, et al. (1995) Criteria for the prenatal diagnosis of classic bladder exstrophy. Obstet Gynecol 85: 961.PubMedCrossRefGoogle Scholar
  14. 14.
    Mirk M, Calisti A, Feleni A. (1986) Prenatal sonographic diagnosis of bladder exstrophy. J Ultrasound Med 5: 291.PubMedGoogle Scholar
  15. 15.
    Verco PW, Khor BH, Barbary J, et al. (1986) Ectopic vesicae in utero. Australas Radiol 30: 117.PubMedCrossRefGoogle Scholar
  16. 16.
    Dodson J, Jeffs RD, Gearhart JP (2001) The newborn exstrophy bladder inadequate for primary closure: evaluation, management and outcome. J Urol 165: 1656–1659.PubMedCrossRefGoogle Scholar
  17. 17.
    Gearhart JP, Peppas DS, Jeffs RD. (1993) Failed exstrophy closure: strategy for management. Br J Urol 71; 217.PubMedCrossRefGoogle Scholar
  18. 18.
    Sponseller PD, Gearhart JP, Jeffs RD. (1991) Anterior innominate osteotomies for failure or late closure bladder exstrophy. J Urol 146: 137.PubMedGoogle Scholar
  19. 19.
    Gearhart JP, Forschner DC, Jeffs RD et al. (1996) A combined vertical and horizontal pelvic osteotomy approach for primary and secondary repair of bladder exstrophy. J Urol 155: 689.PubMedCrossRefGoogle Scholar
  20. 20.
    Hanna MN. (1986) Reconstruction of the umbilicus during functional closure of bladder exstrophy. Urol 27: 350.CrossRefGoogle Scholar
  21. 21.
    Gearhart JP, Jeffs RD. (1991) Management of the failed exstrophy closure. J Urol 146: 610.PubMedGoogle Scholar
  22. 22.
    Grady R, Mitchell ME. (1999) Complete repair of exstrophy. J Urol 162: 1415.PubMedCrossRefGoogle Scholar
  23. 23.
    Chan D, Jeffs RD, Gearhart JP (2001) Determinants of continence after bladder neck reconstruction in the bladder exstrophy population. Urology 57: 775.Google Scholar

Copyright information

© Springer Science+Business Media New York 2003

Authors and Affiliations

  • John P. Gearhart
  • Fernando A. Ferrer

There are no affiliations available

Personalised recommendations