Exstrophy of bladder: verdict or the realities of life in patient of reproductive age?

Abstract

Exstrophy of bladder is a rare congenital malformation of the bladder with the lack of its front wall and, consequently, the anterior abdominal wall, which is often accompanied by epispadias, inguinal hernia, prolapse of the rectum, anomalies of the upper urinary tract. Its exstrophy of bladder frequency ranges on average from 1:10 000 to 1:50 000 newborns, in boys 3-6 times more often than girls. Without surgical treatment half of children with this disorder do not live to the age of 10, and 75% die in age 15.
This article describes a clinical case of a patient M., 18 years old, who was admitted to the gynecological department number 1 of the Donetsk Regional center for maternal and child health for forming of vagina. The patient had a congenital malformation of the genitourinary system in the form of bladder exstrophy, at age 2 and 5 she had reconstructing operations to form the front abdominal wall of local fabrics, made at age 7 reconstruction of bladder neck has not led to a controlled urinate. Internal genital organs with no pathology except atresia of the vagina. After careful examination, using modern laboratory, instrumental and apparatus research methods patient M. was performed laparotomy in a volume: old postoperative scar excision; formation of rectal bladder, ureterorectostomia and bringing down the sigmoid colon by Duhamel; vaginoplasty.
Surveillance for 75 days after the operation showed the following results: control urination and defecation, lack of urine leakage from the anterior abdominal wall and the presence of formed vagina, improving the quality of life and patient’s reproductive plans.
This considered a clinical case illustrates the high efficiency of treatment of bladder exstrophy with individual methodological approach to the selection of an adequate surgical tactics.