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

2018 ◽  
Vol 45 (6) ◽  
pp. 435-440 ◽  
Author(s):  
Julie Antomarchi ◽  
Daniel Moeglin ◽  
Hélène Laurichesse ◽  
Danièle Combourieu ◽  
Nicole Bigi ◽  
...  
Keyword(s):  
Bladder Exstrophy ◽  
Pubic Diastasis

Orthopaedic Management of Bladder Exstrophy

2021 ◽  
Author(s):  
R. Özgür Özer
Keyword(s):  
Abdominal Wall ◽  
Bladder Exstrophy ◽  
Pelvic Osteotomy ◽  
Orthopedic Procedures ◽  
Suture Materials ◽  
Cloacal Exstrophy ◽  
Surgical Interventions ◽  
Pubic Rami ◽  
Multi Stage ◽  
Pubic Diastasis

Bladder exstrophy is an embryologic malformation that affects urogenital and skeletal systems. Non-operative treatment of this rare problem is impossible. Urogenital reconstructions can be facilitated by orthopedic procedures. These reconstructions can be performed in a single stage as a complete repair or multi-stage approaches. The goal of the treatment is closure of the bladder and abdominal wall for the achievement of continence, preservation of renal functions, and cosmetic and functional reconstruction of genital organs. Orthopedic procedures are performed to decrease the tension that complicates the bladder and abdominal wall closure by approximating the pubic rami to achieve a secure closure and a low recurrence rate. Surgical interventions consist of the approximation of the pubic rami with different materials such as suture materials and plaque or the application of different osteotomy types such as posterior iliac, anterior pelvic (pubic), diagonal iliac, horizontal iliac and posterior pelvic resection osteotomies. The age of the patient, the amount of pubic diastasis and history of previous operations that the patient has undergone should be considered during the operation planning. Pubic rami can be approximated without performing pelvic osteotomy in patients who are operated within the first 72 hours after birth. But, osteotomy is required in children older than 2 years of age with severe pubic diastasis, concomitant cloacal exstrophy and unsuccessful operation history. The surgical team should have enough knowledge and experience to perform different osteotomy types in case of need to combine anterior and posterior iliac osteotomies. With these multidisciplinary approaches, much more successful outcomes could be achieved.

scholarly journals Image of the Month: Clinical Features in a Newborn with Covered Cloacal Exstrophy

2017 ◽  
Vol 05 (01) ◽  
pp. e57-e59
Author(s):  
Alejandra Vilanova-Sánchez ◽  
Christina Ching ◽  
Alessandra Gasior ◽  
Karen Diefenbach ◽  
Richard Wood ◽  
...  
Keyword(s):  
Imperforate Anus ◽  
Bladder Exstrophy ◽  
Anorectal Malformations ◽  
Clinical Findings ◽  
Interesting Case ◽  
Pubic Bone ◽  
Newborn Period ◽  
Cloacal Exstrophy ◽  
Pubic Diastasis ◽  
Severe Type

AbstractCloacal exstrophy is the most severe type of anorectal malformations that belongs to the bladder–exstrophy–epispadias complex of genitourinary malformations. Interestingly, its variant, the covered cloacal exstrophy, is often missed. The clinical findings of this variant may include an imperforate anus, low lying umbilicus, thick pubic bone, and pubic diastasis but with an intact abdominal wall. We present an interesting case of covered cloacal exstrophy with a side-by-side duplicated bladder and discuss important considerations for the time of colostomy creation in the newborn period.

scholarly journals Management of Urinary Incontinence in Complete Bladder Duplication by Injection of Bulking Agent at Bladder Neck Level into the Proximal Urethra

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Reza Khorramirouz ◽  
Seyedeh Sanam Ladi Seyedian ◽  
Sorena Keihani ◽  
Abdol-Mohammad Kajbafzadeh
Keyword(s):  
Urinary Incontinence ◽  
Bladder Neck ◽  
Wide Spectrum ◽  
Bladder Exstrophy ◽  
Bulking Agent ◽  
Rare Entity ◽  
Bladder Duplication ◽  
Wide Variability ◽  
Pubic Diastasis ◽  
Proximal Urethra

Bladder duplication is a rare entity in children. The term encompasses a wide spectrum of anomalies from isolated bladder duplication in coronal or sagittal planes to duplicated bladder exstrophy and associated musculoskeletal and visceral anomalies. Given this wide variability, the treatment of these patients is not standardized. We hereby present a female patient with chief complaint of long-standing urinary incontinence who had complete bladder and urethral duplication and pubic diastasis. The patient was treated with bulking agent injection at the incompetent bladder neck and proximal urethra with resolution of incontinence, obviating the need for extensive surgeries.

scholarly journals Total hip arthroplasty in patients with severe hip dysplasia and congenital pubic diastasis: report of two cases

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Christian Goetze ◽  
Filippo Migliorini ◽  
Christian Dominik Peterlein
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Hip Dysplasia ◽  
Bladder Exstrophy ◽  
Case Series ◽  
Hip Osteoarthritis ◽  
Cementless Stem ◽  
Level Of Evidence ◽  
Total Hip ◽  
Pubic Diastasis

Abstract Background Congenital bladder exstrophy is a rare malformation which is often associated with pubic diastasis and hip dysplasia. We reported the case two patients who underwent total hip arthroplasty (THA) due to advanced osteoarthritis combined with large congenital pubic diastasis (> 10 cm). Case presentation The first patient, a 39 years old woman with a pubic diastase and severe hip dysplasia on both sides was treated with a primary two-staged bilateral THA. Both hips were treated with a cementless osteoconductive cup (TM, Zimmer-Biomet) and a cementless stem (Alloclassic SL, Zimmer-Biomet). A 10° elevated rim liner of the cup was used in order to avoid dislocation. The main problem was represented by the fixation of the cup, given the retroverted acetabulum along with the elevated rotation centre due to the dysplastic hips. In the case two, a 52 years woman presented dysplastic osteoarthritis of the left hip. A conventional hemispherical cup (Alloclassic-Allofit, Zimmer-Biomet) was placed in the retroverted acetabulum combined with a cementless stem (Fitmore A, Zimmer-Biomet) attached at the metaphyseal proximal femur bone. Conclusion Our results suggest that THA may be a good strategy to manage advanced hip osteoarthritis in patients with dysplasia and congenital pubic diastasis. Level of evidence IV, case series.

scholarly journals Management of bladder exstrophy in an adolescent girl: a case report

2021 ◽  
Author(s):  
Ni Made Putri Suastari ◽  
Ni Nyoman Margiani ◽  
Kadek Budi Santosa ◽  
Dewa Gde Mahiswara ◽  
Firman Parulian Sitanggang ◽  
...  
Keyword(s):  
Case Report ◽  
Ileal Conduit ◽  
Bladder Exstrophy ◽  
Labia Minora ◽  
Rare Congenital Abnormality ◽  
Rare Case Report ◽  
Pubic Diastasis ◽  
Pelvic Radiography ◽  
Vaginal Canal ◽  
Manta Ray

Bladder exstrophy (BE) is a very rare congenital abnormality, especially in girls. We reported a 17-year-old girl with protruded bladder and urinary incontinence. Her vaginal orifice appeared stenotic and shifted anteriorly. She had an incomplete labia minora, short perineum, and anterior displacement of the anus. The pelvic radiography showed a pubic diastasis with a manta ray sign, and the ultrasonography examination showed a bicornuate uterus. She had undergone a functional reconstruction surgery with cystectomy, ileal conduit, appendectomy, and vaginoplasty along with the advancement of abdominal flap reconstruction with multiple Z-plasty. Functionally, she was able to urinate through the ileal conduit comfortably, had a regular menstrual cycle with minimal pain, had a wider vaginal canal, and had a smooth blood flow. Aesthetically, she had a good lower abdomen appearance, remained dry, and had an odorless urine. In clinical practice, this rare case report can provide additional knowledge and management of the same cases with effective results.

scholarly journals Bladder exstrophy with inguinal hernia: a case report

2020 ◽  
Vol 7 (5) ◽  
pp. 1155
Author(s):  
Tazeem Fatima Ansari ◽  
Prachi Gandhi ◽  
Poonam Wade ◽  
Vinaya Lichade Singh ◽  
Kiran Khedkar ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Urinary Bladder ◽  
Bladder Neck ◽  
Inguinal Canal ◽  
Bladder Exstrophy ◽  
Pubic Symphysis ◽  
Pubic Diastasis ◽  
Primary Bladder ◽  
Staged Reconstruction ◽  
Lower Abdominal Wall

Exstrophy of urinary bladder with epispadias involves protrusion of the urinary bladder through a defect in the lower abdominal wall accompanied by separation of pubic symphysis. It is a rare but challenging condition that causes significant physical, functional, social, sexual and psychological problems later in life. Bladder exstrophy commonly involves males and most cases are sporadic.  Inguinal hernia is a complication associated with bladder exstrophy and it occurs due to lack of obliquity of the inguinal canal secondary to pubic diastasis.  Authors report here, a case of antenatally diagnosed case of classic bladder exstrophy associated with left sided inguinal hernia which was incidentally diagnosed on tenth day of life. Our neonate underwent primary bladder closure with herniotomy. Staged reconstruction of epispadias and bladder neck has been planned at a later date. Recurrence of inguinal hernia after repair is common and bilateral inguinal exploration while performing herniotomy is advised to prevent its recurrence. Prognosis of such cases depends on the degree of continence achieved. With timely reconstructive surgery, continence rates can be as high as 60-70 percent.

Hip Arthroplasty in a Patient with Congenital Pubic Diastasis and Bladder Exstrophy

2009 ◽  
Vol 19 (2) ◽  
pp. 155-156
Author(s):  
Andrea Camera ◽  
Guido Grappiolo ◽  
Giuseppe Santoro
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Bladder Exstrophy ◽  
Total Hip ◽  
Satisfactory Outcome ◽  
Pubic Diastasis

We report a total hip arthroplasty performed for arthritis and osteonecrosis in a patient with congenital pubic diastasis and bladder exstrophy. A satisfactory outcome was achieved after appropriate consideration of the technical and biomechanical issues involved.

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