Bladder exstrophy: reconstructed female patients achieving normal pregnancy and delivering normal babies

Abstract

Purpose: Bladder exstrophy (BE) is an anterior midline defect that causes a series of genitourinary and muscular malformations, which demands surgical intervention for correction. Women with BE are fertile and able to have children without this disease. The purpose of this study is to assess the sexual function and quality of life of women treated for BE. Materials and Methods: All patients in our institution treated for BE from 1987 to 2007 were recruited to answer a questionnaire about their quality of life and pregnancies. Results: Fourteen women were submitted to surgical treatment for BE and had 22 pregnancies during the studied period. From those, 17 pregnancies (77.2%) resulted in healthy babies, while four patients (18.1%) had a spontaneous abortion due to genital prolapse, and there was one case (4.7%) of death due to a pneumopathy one week after delivery. There was also one case (5.8%) of premature birth without greater repercussions. During pregnancy, three patients (21.4%) had urinary tract infections and one patient (7.14%) presented urinary retention. After delivery, three patients (21.4%) presented temporary urinary incontinence; one patient (7.14%) had a vesicocutaneous fistula and seven patients (50%) had genital prolapsed. All patients confirmed to have achieved urinary continence, a regular sexual life and normal pregnancies. All patients got married and pregnant older than the general population. Conclusions: BE is a severe condition that demands medical and family assistance. Nevertheless, it is possible for the bearers of this condition to have a satisfactory and productive lifestyle.

Essentials of bladder cancer worldwide: incidence, mortality rate and risk factors

“…These abnormalities are often seen in boys and often accompanied by abnormalities of the reproductive system and the anus. Surgery immediately after birth causes the bladder and abdominal wall to be closed (and repairs the related defects), but those who have not yet had a surgery are at higher risk for urinary tract infections and BC (Giron et al, 2011;Zhang et al, 2013).…”

Management of narrow introitus with Fenton's operation followed by successful pregnancy in a woman with repaired bladder exstrophy

“…Th e incontinence persists in 1/4, according to a study (Giron et al 2011). Other complications in pregnancy, of rare occurrence, are urinary retention and vesico-cutaneous fi stulas.…”

“…A higher rate of abortions, i.e. up to 18% and pregnancy-related morbidities in 12% has also been reported in these women (Giron et al 2011). Although no genetic cause has been identifi ed, there is a 0.5 -3% chance of recurrence in the family of an aff ected individual.…”

“…Bladder exstrophy is a rare congenital anomaly, with incidence varying from 1:30,000 -1:50,000 live births; involvement of females being rarer (Giron et al 2011). It involves maldevelopment of the infraumbilical anterior abdominal wall, urinary tract, external genitalia and pelvis.…”

Pregnancy in case of exstrophy of bladder

“…It is associated with complex genitourinary malformations, requiring difficult surgical treatment. 1 Because of multi-staged bladder and pelvic reconstructive surgeries in these patients, obstetric management presents a challenge and needs multidisciplinary approach by obstetrician and urosurgeon. Preconceptional renal evaluation and regular follow up in antenatal period should be done.…”