Prevalence and Repair of Inguinal Hernias in Children with Bladder Exstrophy

Abstract

Children with bladder exstrophy should be carefully examined for inguinal hernias before bladder closure. If a unilateral hernia is present, the contralateral side should be explored. Careful preperitoneal repair should emphasize repair of the internal ring.

Testicular Tumors in Patients with Exstrophy-Epispadias Complex

“…Due to the open processus, abnormal scrotal morphology and lack of intra-abdominal pressure with decreased local intramuscular forces, inguinal hernia is a frequent complication of EEC in male newborns. 3,4 In current pediatric urology textbooks the testes in bladder exstrophy are reportedly "frequently undescended but without the need for orchiopexy." 5 In the literature the overall incidence of inguinal hernia in males with exstrophy is about 82% and the condition most often is bilateral, either synchronically or metachronically.…”

“…5 In the literature the overall incidence of inguinal hernia in males with exstrophy is about 82% and the condition most often is bilateral, either synchronically or metachronically. 3 In exstrophy a remarkably wide defect of the internal ring and a lack of obliquity of the inguinal canal have been described as relevant confounding factors. Furthermore, the timing of observation seems relevant, as only 25% of inguinal hernias are found before bladder closure, emphasizing the importance of increased intra-abdominal pressure after abdomen closure to show the underlying pathology.…”

“…Conversely it is common knowledge that despite normal cord length, the unique anatomy of the anterior pelvic ring and the inguinal canal in males with classic bladder exstrophy predispose to congenital inguinal hernia and possibly malpositioned testes not requiring orchiopexy. [3][4][5] Additionally there is sparse information in the medical literature on the long-term testicular outcome after hernia, exstrophy and epispadias repair among males with EEC. Furthermore, in adulthood infertility is common in patients with EEC, although this finding is mainly understood as a consequence of obstruction caused by bladder neck or urethral surgery, or epididymitis during childhood and adolescence.…”

Exstrophy-Epispadias Complex

“…The intrasymphyseal band connects the posterior urethra and bladder neck to the diastatic pubic rami. Often there may be an associated, small umbilical hernia, and indirect inguinal hernias are often found due to persistence of the processus vaginalis, enlarged inguinal rings, and rotated inguinal canals due to the pelvic deformity [20]. Omphaloceles are common in conjuction with CE.…”

Current management of bladder exstrophy

“…The umbilicus lies more caudad than normal, just superior to the cephalad apex of the defect. Inguinal hernias occur in up to 82% of boys and 11% of girls with bladder exstrophy [4]. The perineum is short and broad and the anus is displaced anteriorly, situated directly behind the urogenital diaphragm demarcating the posterior limit of the triangular fascial defect [5].…”