Variations in exstrophy of the bladder

Marshall, Victor F.; Muecke, Edward C.

doi:10.1097/00006534-196304000-00030

Cited by 24 publications

(40 citation statements)

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“…In the past, concepts to explain the morphogenesis of the EEC were based on the patho-morphological conditions found in fetal and postnatal human cases (Wood Jones 1912;Johnston 1913;Marshall and Muecke 1962) or were deduced from studies of normal embryonic development (Wyburn 1937;Patten and Barry 1952). From the plethora of previously published concepts only a few alternative hypotheses are currently being considered in the biomedical literature.…”

Section: Discussionmentioning

confidence: 99%

“…It is usually thought that the common patho-morphological feature of all the different types of malformations of the EEC-namely the presence of an abnormal external opening of the bladder or cloaca cranial to the penis or clitoris-principally results from the same abnormal morphogenetic events (Patten and Barry 1952;Marshall and Muecke 1962;Ambrose and O'Brien 1974). These morphogenetic events, however, are still a matter of speculation.…”

Section: Introductionmentioning

confidence: 99%

“…This is due primarily to the lack of availability of abnormal human as well as non-human embryos showing the crucial developmental steps involved in the morphogenesis of the EEC (Patten and Barry 1952). Concepts to explain the morphogenesis of the malformations of the EEC, therefore, have been inferred from the patho-morphological conditions seen in fetal or postnatal human cases (Wood Jones 1912;Johnston 1913;Marshall and Muecke 1962) or deduced from studies of the normal embryonic morphogenesis (Wyburn 1937;Patten and Barry 1952). These approaches, however, did not clarify but merely confused the situation since they led to publications of a plethora of alternative concepts on the morphogenesis of the EEC.…”

Section: Introductionmentioning

confidence: 99%

“…Some of these concepts attribute the morphogenesis of the malformations of the EEC primarily to developmental defects of the cloacal membrane (Marshall and Muecke 1962). Since cloacal exstrophy has successfully been induced in chick embryos by surgical interference with normal development of the area presumed to harbour the cloacal membrane (Muecke 1964; Thomalla et al 1985), these concepts have become most popular in explaining the morphogenesis of the EEC.…”

Section: Introductionmentioning

confidence: 99%

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The morphogenesis of the exstrophy-epispadias complex: a new concept based on observations made in early embryonic cases of cloacal exstrophy

Männer

Kluth

2005

Anat Embryol

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Besides the presence of an abnormal opening into the cloaca, all embryos were characterised by an abnormal broadening of the caudal trunk at the level of the leg buds, which, in the youngest embryos, was associated with the abnormal presence of large aneurysmatic swellings of the dorsal aortae at this side. We postulate that these aneurysmatic swellings might be the primary defects leading to the development of EEC malformations. These space-occupying anomalies seem to cause abnormal distensions of the developing pelvis and of the infra-umbilical portion of the developing body wall. In consequence, the mid-portion of the developing ventral body wall between the origin of the umbilical cord and the cloacal plate becomes stretched and thinned out. Tension and thinning of the ventral body wall might ultimately lead to its rupture with exposure of the lumen of the embryonic cloaca and allantois. This new concept on the morphogenesis of the EEC is the first not to be inferred from the conditions seen in fetal or postnatal human cases but is based entirely on data from malformed embryos.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The morphogenesis of the exstrophy-epispadias complex: a new concept based on observations made in early embryonic cases of cloacal exstrophy

Männer

Kluth

2005

Anat Embryol

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“…1) and its variants represent a challenging field because of the peculiar association of skeletal and visceral abnormalities (Jeffs 1978;Loder and Dayioglu 1990). Many developmental patterns have been suggested, yet they usually involve the cloacal membrane and its defective evolution (Johnston 1913;Wyburn 1937;Patten and Barry 1952;Marshall and Muecke 1962;Mildenberger et al 1988). In addition, none of them accounts satisfactorily for all the clinical features encountered in affected children (Magnus 1969;Manzoni et al 1987;Lascombes et al 1989).…”

Section: Introductionmentioning

confidence: 99%

Pelvic development in the rabbit embryo: implications in the organogenesis of bladder exstrophy

Beaudoın

Barbet

Bargy³

2004

Anat Embryol

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Current theses of the development of bladder exstrophy and its variants rely on defective evolution of the urinary tract and cloacal membrane. They do not account satisfactorily for the clinical features reported in children affected by exstrophy, especially the pelvic bone anomaly. We herein describe the normal development of the pelvic ring in the rabbit embryo and its chronological relationship with the lower urinary tract organogenesis. Our results suggest that these events are intricated and allow us to propose a novel mechanism to explain exstrophies.

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Exstrophy of the cloaca and exstrophy of the bladder: Two different expressions of a primary developmental field defect

et al. 2001

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Exstrophy of the bladder (EB) and exstrophy of the cloaca (EC) are generally recognizable as distinct clinical entities. In patients with EB, the posterior bladder wall is exposed through a midline defect of the abdomen. The umbilicus is inferiorly displaced and located close to the superior margin of the exstrophic bladder. Genital abnormalities are common in boys and girls who may present epispadias and a small, split phallus or a split clitoris, a bifid uterus, and a duplicate or exstrophic vagina. In contrast to classic EB, EC is commonly associated with omphalocele, spinal defects, and incompletely formed external genitalia and is always associated with imperforate anus. Some authors state that EC and EB constitute two distinct disorders, but others consider them part of a "continuum," representing different levels of severity within the same spectrum. The use of the acronym OEIS to refer to the combination of omphalocele, exstrophy, imperforate anus, and spinal defects, in our opinion, has not helped to clarify the clinical definition, pathogenesis, or cause of this multiple congenital anomaly (MCA) pattern, mostly because the term makes no distinction between EC or EB. Here we present the epidemiological analysis of a group of characteristics in infants with EC and infants with EB to determine if they constitute two different entities. We also analyze if the different combinations of omphalocele, imperforate anus, and spinal defects are more frequent in infants with EC than in infants with MCA patterns other than EC and EB. The prevalence in our data for EC was 1:200,233 live births and 1:35,597 for EB. The clinical analysis indicated that the study defects (omphalocele, spine defects, spina bifida, and imperforate anus) tend to occur together in the same child with a higher frequency if the child has the EC defect than in infants with MCA patterns that did not include EC or EB. Our findings of low birth weight, twinning, single umbilical artery, and preferentially associated malformations suggest that EC is the result of damage occurring very early in development and that EC and EB are two different expressions of a primary polytopic developmental field defect.

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Variations in exstrophy of the bladder

Cited by 24 publications

References 0 publications

The morphogenesis of the exstrophy-epispadias complex: a new concept based on observations made in early embryonic cases of cloacal exstrophy

The morphogenesis of the exstrophy-epispadias complex: a new concept based on observations made in early embryonic cases of cloacal exstrophy

Pelvic development in the rabbit embryo: implications in the organogenesis of bladder exstrophy

Exstrophy of the cloaca and exstrophy of the bladder: Two different expressions of a primary developmental field defect

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