Novel Observations of Female Genital Anatomy in Classic Bladder Exstrophy Using 3-Dimensional Magnetic Resonance Imaging Reconstruction

Benz, Karl; Dunn, Emily; Solaiyappan, Meiyappan; Maruf, Mahir; Kasprenski, Matthew; Jayman, John; Michaud, Jason; Facciola, James; DiCarlo, Heather; Gearhart, John P.

doi:10.1016/j.juro.2018.04.071

Cited by 6 publications

(3 citation statements)

References 16 publications

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“…The cause of this disease is still unclear and there is no history. Cases of bladder exstrophy in boys are more common in girls with a ratio of 2:1 [ 13 ].…”

Section: Reviewmentioning

confidence: 99%

Analyzing the factors that contribute to the development of embryological classical type of bladder exstrophy

Margiana,

Juwita,

Ima

et al. 2023

Anat Cell Biol

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Bladder exstrophy is a rare congenital condition of the pelvis, bladder, and lower abdomen that opens the bladder against the abdominal wall, produces aberrant growth, short penis, upward curvature during erection, wide penis, and undescended testes. Exstrophy affects 1/30,000 newborns. The bladder opens against the abdominal wall in bladder exstrophy, a rare genitourinary condition. This study is vital to provide appropriate therapy choices as a basis to improve patient outcomes. This study may explain bladder exstrophy and provide treatment. Epispadias, secretory placenta, cloacal exstrophy, and other embryonic abnormalities comprise the exstrophy-spades complex. The mesenchymal layer does not migrate from the ectoderm and endoderm layers in the first trimester, affecting the cloacal membrane. Embryological problems define the exstrophy-aspidistra complex, which resembles epimedium, classic bladder, cloacal exstrophy, and other diseases. Urogenital ventral body wall anomalies expose the bladder mucosa, causing bladder exstrophy. Genetic mutations in the Hedgehog cascade pathway, Wnt signal, FGF, BMP4, Alx4, Gli3, and ISL1 cause ventral body wall closure and urinary bladder failure. External factors such as high maternal age, smoking moms, and high maternal body mass index have also been associated to bladder exstrophy. Valproic acid increases bladder exstrophy risk; chemicals and pollutants during pregnancy may increase bladder exstrophy risk. Bladder exstrophy has no identified cause despite these risk factors. Exstrophy reconstruction seals the bladder, improves bowel function, reconstructs the vaginal region, and restores urination.

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“…The cause of this disease is still unclear and there is no history. Cases of bladder exstrophy in boys are more common in girls with a ratio of 2:1 [ 13 ].…”

Section: Reviewmentioning

confidence: 99%

Analyzing the factors that contribute to the development of embryological classical type of bladder exstrophy

Margiana,

Juwita,

Ima

et al. 2023

Anat Cell Biol

View full text Add to dashboard Cite

show abstract

“…The split clitoris is usually left untouched to protect the delicate nerve supply and to avoid scaring caused by later re-dehiscence of the symphysis. Recently Benz et al were able to show that contrary to the corpora cavernosa in boys, girls with BE have the majority of the clitoral body anterior to the pelvic attachment (39). Skin and tissue retraction in the mons pubis area is cosmetically improved by mobilizing adjacent inguinal tissue and rotating it medially into the affected area.…”

Section: Epispadias Repairmentioning

confidence: 99%

“…However, it is known that symphysis diastasis recurs after all commonly used pelvic closure techniques (43). There are only a few studies dealing with pubic diastasis after various types of pelvic osteotomy in a reasonable follow-up (36–39). According to these data the distance of recurrent mean pubic diastasis is not differing relevant in the long-term with and without osteotomy (Table 2).…”

Section: Need Of Osteotomiesmentioning

confidence: 99%

Recent Trends in the Management of Bladder Exstrophy: The Gordian Knot Has Not Yet Been Cut

Promm¹,

Roêsch²

2019

Front. Pediatr.

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Although enormous effort has been made to further improve the operative techniques worldwide, the management of bladder exstrophy (BE) remains one of the most significant challenges in pediatric urology. Today it is universally agreed that successful and gentle initial bladder closure is decisive for favorable long-term outcome with regard to bladder capacity, renal function and continence. Due to a number of reasons, including a lack of comparable multicenter studies, a range of concepts is currently used to achieve successful primary closure. We review the literature of the last 15 years on the current concepts of bladder exstrophy repair with regard to the time of primary closure (initial vs. delayed closure), the concepts of primary closure (single-stage vs. staged approach; without osteotomy vs. osteotomy) and their outcomes. There is a worldwide lack of multicenter outcome studies with adequate patient numbers and precisely defined outcome parameters, based on the use of validated instruments. The modern staged repair (MRSE) in different variations, the complete primary reconstruction of exstrophy (CPRE), and the radical soft-tissue mobilization (RSTM) had been the most extensively studied and reported procedures. These major concepts are obligatory stable now for more than 20 years. Nevertheless, there are still a lot of open-ended questions e.g., on the potential for development of the bladder template, on continence, on long-term orthopedic outcome, on sexuality and fertility and on quality of life. Management of BE remains difficult and controversial. Further, clinical research should focus on multi-institutional collaborative trials to determine the optimal approach.

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Anatomy of Classic Bladder Exstrophy: MRI Findings and Surgical Correlation

et al. 2019

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Novel Observations of Female Genital Anatomy in Classic Bladder Exstrophy Using 3-Dimensional Magnetic Resonance Imaging Reconstruction

Abstract: This study uncovers the uniquely novel finding that contrary to their male counterparts, females with classic bladder exstrophy have the majority of the clitoral body anterior to the pelvic attachment. This discovery has surgical and embryological implications.

Cited by 6 publications

References 16 publications

Analyzing the factors that contribute to the development of embryological classical type of bladder exstrophy

Analyzing the factors that contribute to the development of embryological classical type of bladder exstrophy

Recent Trends in the Management of Bladder Exstrophy: The Gordian Knot Has Not Yet Been Cut

Anatomy of Classic Bladder Exstrophy: MRI Findings and Surgical Correlation

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