Repairing a bladder exstrophy means surgery, and can involve replacing the bladder back into the body, but also readjusting other pelvic structures to restore normal or near-normal function.
Other names for this surgery may be bladder birth defect repair, everted bladder repair, repair of bladder exstrophy, or exposed bladder repair.
Reason for surgery
The exposed organs must be moved back into the abdomen so the person can have normal urinary control, avoid future sexual problems (or limit them), improve the physical appearance of the genitals, and prevent recurrent infections.
The surgery is usually done a few days after birth, with other surgeries coming later if required. The bladder must be big enough to tolerate surgery. If the bladder is not big enough, the baby can be sent home with antibiotics, and parents will be taught how to stop the bladder from becoming dry. Generally, however, the surgery will be done at the hospital before the baby is sent home.
Preparing for the bladder exstrophy repair surgery
A postponed surgery means testing – urine tests for infection, kidney tests, blood tests, x-rays, and ultrasounds. Additionally, good records should be kept about your observations, but also how much urine your child is producing. Medications that should be avoided 10 days before surgery include any that affect blood clotting such as aspirin, warfarin, and ibuprofen.
Before surgery, no food or drink should be eaten for the number of hours your doctor requests. Over-the-counter drugs and supplements should be discussed with your doctor.
The surgery itself
There are two separate surgeries involved in a bladder exstrophy repair, with the first repairing the bladder, and the second repairing the attachment between the pelvic bones.
Surgery 1 – the bladder
The exposed bladder is separated from the abdominal wall, and then the bladder is closed. The neck of the bladder and the urethra are repaired. A catheter to drain urine from your child’s body will be placed into the bladder and protrude from the abdomen, and another from the urethra. This helps the body to heal.
Surgery 2 – the pelvic bones
The attachment between pelvic bones is repaired. This could occur at the same time as the bladder, or be rescheduled.
There may be more, depending on the circumstances and severity. If the issue has affected the bowel or other structures, more surgery may be required. Some surgeries are also performed when the child is older, including genital cosmetic procedures.
The baby will need to stay in hospital to be monitored for up to six weeks. The first three or four weeks will see the baby with a catheter from the bladder to the outside abdomen, and the baby will need a pelvic sling. The pelvic bones have been separated.
General wound care, pain relief, and antibiotics are used as required. Follow-up includes tests to check for infection.
Outcomes of the surgery
Successful surgery occurs most of the time, and results in normal urinary control, improved appearance of the genitals, reduced sexual function issues in future, and the prevention of infections and kidney troubles later.
If the surgery is unsuccessful in any degree, it may be repeated, and in some cases, incontinence is an unavoidable outcome requiring a lifetime catheter.
Risks of the bladder exstrophy repair surgery
There is a risk involved in every surgery, but the risks are less likely that if the repair is not pursued. The problems that can arise with this type of surgery are:
- Poor urinary control
- Urinary tract infections
- Sexual function issues
- Kidney function problems
- Further surgery required
- Risks of anaesthetic use (breathing, adverse drug reactions)