Antenatal diagnosis of bladder/cloacal exstrophy: Challenges and possible solutions

Goyal, Anju; Fishwick, Janet; Hurrell, Ruth; Cervellione, Raimondo M.; Dickson, Alan P.

doi:10.1016/j.jpurol.2011.05.003

Cited by 57 publications

(32 citation statements)

References 12 publications

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“…Besides, visualization of the umbilical artery pathway around the budding bladder plate is also important in determining the origin of the sub-umbilical mass [14, 15]. However, the diagnostic relevance of these criteria remains poor, between 25 and 33% according to the studies [4, 5]. In contrast, in our prospective monocentric study of 1,549 fetuses, except for some cases not measurable for technical reasons, the pubic diastasis measurement was feasible in 94.74% of cases.…”

Section: Discussionmentioning

confidence: 99%

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The Pubic Diastasis Measurement, a Key Element for the Diagnosis, Management, and Prognosis of the Bladder Exstrophy

Antomarchi¹,

Moeglin²,

Laurichesse

et al. 2018

Fetal Diagn Ther

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Objective: To demonstrate the feasibility of measuring the fetal pubic diastasis (PD) distance on antenatal ultrasound in normal fetuses and to compare it to fetuses with bladder exstrophy. Methods: Firstly, a prospective multicentric study was conducted to determine the feasibility of the PD ultrasound measurement during the second half of pregnancy. Secondly, data from a single center were used to develop a nomogram for PD values in normal fetuses. Thirdly, retrospective PD measurements were collected from fetuses with bladder exstrophy, diagnosed in seven French Multidisciplinary Centers for Prenatal Diagnosis (MCPDs). Results: Operators from several MCPDs examined 868 fetuses and found that overall PD ultrasound measurement was feasible in 71% of cases and that the ossification of pubic points increased to be always visible from 27 weeks of gestation onward. Performed in a single center by a referring operator on 1,539 fetuses, the feasibility reached 94.74%. Both set of measurements were concordant (mean PD distance value of 5.42 ± 1.8 mm). Interestingly, all 23 fetuses with bladder exstrophy showed a significantly larger PD distance (mean 15.74 ± 3.9 mm). Conclusion: PD measurement in the fetus is feasible and reliable in the second half of gestation and can be used to support the antenatal diagnosis of bladder exstrophy with PD values exceeding 10 mm.

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Section: Discussionmentioning

confidence: 99%

“…However, the diagnostic relevance of these criteria is poor, 8% for isolated cases with single exstrophy and 25% for OEIS [5]. …”

Section: Introductionmentioning

confidence: 99%

The Pubic Diastasis Measurement, a Key Element for the Diagnosis, Management, and Prognosis of the Bladder Exstrophy

Antomarchi¹,

Moeglin²,

Laurichesse

et al. 2018

Fetal Diagn Ther

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“…Ultrasound can yield a diagnosis as early as 15 weeks [30] with findings such as the absence of bladder filling, widened pubic rami, diminutive genitalia (male), and a lower abdominal mass that enlarges in size which is the bladder plate [31,32]. Surprisingly, despite very uniform ultrasound findings, only 25 % of cases are detected antenatally [33]. Prompt diagnosis and referral to a center of excellence is paramount to decrease both morbidity and mortality perioperatively [34], especially with CE.…”

Section: Diagnosismentioning

confidence: 99%

Exstrophy-Epispadias Complex

Stuhldreher¹,

Inouye²,

Gearhart³

2015

Curr Bladder Dysfunct Rep

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Bladder exstrophy is a complex congenital birth defect ranging from complete epispadias to complete bladder exstrophy. Though not included in the exstrophy-epispadias complex (EEC) disease spectrum, cloacal exstrophy is a more severe form which includes bowel segments in the defect and has many of the same defects as the EEC. Initial care of these complex patients focuses on the primary repair of the defect, a repair which is the most important of the many operations these children will have in their lifetime. A failure of primary closure is associated with worse outcomes across the board. The most essential goal in treatment of the exstrophy patient is renal protection. Once that can be assured, social continence then becomes the most important goal. Given the complex nature of this disorder, these children should be managed at speciality centers with orthopedic, urologic, and nursing experience with these patients.

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“…However, early prenatal diagnosis of a cloacal exstrophy remains a challenge because of its complicated associated anomalies [3]. In a serial study, only 25% of cases can accurately be diagnosed prenatally [3]. In this study, even those pregnancies that did not result in a live birth were taken into account; a detection rate of only 33% could be achieved [3].…”

Section: Introductionmentioning

confidence: 96%

“…Thus, early prenatal diagnosis and transfer to a tertiary medical center for further neonatal care are very important for these newborns. However, early prenatal diagnosis of a cloacal exstrophy remains a challenge because of its complicated associated anomalies [3]. In a serial study, only 25% of cases can accurately be diagnosed prenatally [3].…”

Section: Introductionmentioning

confidence: 99%

Prenatal Diagnosis of Cloacal Exstrophy: A Case Report and Differential Diagnosis with a Simple Omphalocele

Chou

Tseng

Lai

2015

Journal of Medical Ultrasound

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KEY WORDSanterior abdominal wall defect, cloacal exstrophy, omphalocele Cloacal exstrophy is a rare congenital disorder that may lead to mortality and morbidity. Although the prenatal diagnosis of cloacal exstrophy can be made by a midtrimester ultrasound, it is difficult to differentiate it from a simple omphalocele that can be corrected completely by surgery without morbidity. We reported a case with cloacal exstrophy and reviewed previous literature on differentiating it from an omphalocele. A 33-year-old, pregnant female visited our outpatient center for prenatal care at the 22 nd gestational week. The midtrimester ultrasound showed fetal anomalies including a protruding mass from umbilicus, absence of bladder, ambiguous genitalia, and bilateral renal hydronephrosis. The parents received prenatal genetic counseling and decided to continue the pregnancy. A female baby was delivered at the 37 th gestational week via vaginal delivery, and cloacal exstrophy without omphalocele was diagnosed. Cloacal exstrophy is a complicated congenital disorder that should be differentiated from a simple omphalocele. Prenatal counseling and postnatal care in a tertiary medical center are important for parents and the fetus, respectively. ª

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Antenatal diagnosis of bladder/cloacal exstrophy: Challenges and possible solutions

Cited by 57 publications

References 12 publications

The Pubic Diastasis Measurement, a Key Element for the Diagnosis, Management, and Prognosis of the Bladder Exstrophy

The Pubic Diastasis Measurement, a Key Element for the Diagnosis, Management, and Prognosis of the Bladder Exstrophy

Exstrophy-Epispadias Complex

Prenatal Diagnosis of Cloacal Exstrophy: A Case Report and Differential Diagnosis with a Simple Omphalocele

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