Exstrophy of Bladder

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Disease Ontology 12 DOID:0080174 OMIM 56 600057 ICD9CM 34 753.5 MeSH 43 D001746 ICD10 32 Q64.10 MESH via Orphanet 44 D001746

ICD10 via Orphanet 33 Q64.1 UMLS via Orphanet 72 C0005689 Orphanet 58 ORPHA93930 MedGen 41 C0005689 SNOMED-CT via HPO 68 18735004 197811007 197927001 253789002 263681008 29980002 34911001 396232000 396347007 406477003 41729002 48641006 55726006 61758007 69758005 72042002 95576001 more UMLS 71 C0005689

NIH Rare Diseases : ⁵² The following summary is from Orphanet , a European reference portal for information on rare diseases and orphan drugs. Orpha Number: 93930 Definition A congenital genitourinary malformation belonging to the spectrum of the exstrophy-epispadias complex (EEC) and is characterized by an evaginated bladder plate, epispadias and an anterior defect of the pelvis, pelvic floor and abdominal wall. Epidemiology The prevalence at birth for the EEC is reported at 1/10,000. As epispadias (E), classic bladder exstrophy (CEB) and cloacal exstrophy (EC) are now recognized clinical variants of the same spectrum, accurate epidemiological data on E/EC/CEB are no longer available. However, CEB appears to be more frequent in the white population. Most studies report a male-to-female ratio of around 2.4:1, but ratios as high as 6:1 have also been reported. Clinical description CEB is evident from birth, with the reddish bladder mucosa being visible in the lower abdomen and mucosal polyps sometimes present on the surface. Urine drips from the ureteric orifices on the bladder surface. Other findings include pubic diastasis of various degrees with divergent rectus muscles and inguinal hernias. In males, the penis is short and broad with dorsal chordee. The urethral plate covers the whole dorsum of the penis from the open bladder to the glandular grove. Both corpora cavernosa are located beneath the urethral plate and the colliculus seminalis and the ductus ejaculatorii are visible as tiny openings in the area where the prostate is presumably dorsally located. Females present with a bifid clitoris next to the open urethral plate. The vaginal opening appears narrow and the perineum is shortened due to the anterior displacement of the vagina and anus. Women with CEB have a predisposition for vaginal or uterine prolapse. Spinal anomalies occur in about 7% of cases but gastrointestinal anomalies are rare in CEB. Etiology CEB results from early abnormal development of the intra-abdominal wall and bladder during rupture of the cloacal membrane. Though the underlying cause remains still unknown, a developmental field defect with both genetic and environmental factors is likely to play a role. Diagnostic methods Diagnosis is clinical. However, during follow-up, laboratory and imagining studies (such as ultrasound of the urogenital system , pelvic MRI or X-ray , voiding cystography and urodynamics) are useful to determine renal function and assess bladder capacity and detrusor function. Management and treatment Management is primarily surgical, with the main aims of obtaining secure abdominal wall closure, achieving urinary continence with preservation of renal function, and, finally, adequate cosmetic and functional genital reconstruction. Currently, several methods for bladder reconstruction with creation of an outlet resistance and epispadias repair (either as a staged or a one-stage approach) during the newborn period are favored worldwide. Removal of the bladder template with complete urinary diversion to a rectal reservoir can be an alternative. Prognosis After reconstructive surgery of the bladder, continence rates of about 80% are expected during childhood. Though spontaneous voiding is the main issue, additional surgery might be needed to optimize bladder storage and emptying function. In cases of definite reconstruction failure, urinary diversion should be undertaken. In puberty, genital and reproductive function constitute increasingly important issues for both sexes. Psychosocial and psychosexual outcome reflect the importance of long-term care (from birth into adulthood) from a multidisciplinary team of experts for parents and children with EEC to facilitate an adequate quality of life. Visit the Orphanet disease page for more resources.

MalaCards based summary : Exstrophy of Bladder, also known as bladder exstrophy, is related to bladder exstrophy-epispadias-cloacal exstrophy complex and nephrogenic adenoma. An important gene associated with Exstrophy of Bladder is ISL1 (ISL LIM Homeobox 1). The drugs Anesthetics and Anesthetics, General have been mentioned in the context of this disorder. Affiliated tissues include prostate, colon and bone, and related phenotypes are umbilical hernia and abnormality of the anus

Disease Ontology : ¹² A bladder exstrophy-epispadias-cloacal exstrophy complex that is characterized by an evaginated bladder plate, epispadias and an anterior defect of the pelvis, pelvic floor and abdominal wall. The rear portion of the bladder wall (posterior vesical wall) turns outward (exstrophy) through an opening in the abdominal wall and urine is excreted through this opening.

OMIM : ⁵⁶ Bladder exstrophy and epispadias complex (BEEC) is an anterior midline defect with variable expression involving the infraumbilical abdominal wall including the pelvis, urinary tract, and external genitalia (Gearhart and Jeffs, 1998). BEEC is one of the most severe urologic birth defects because of its profound impact on continence, sexual function, and morbidity due to the effect of chronic and recurrent infections on renal function. The term 'exstrophy,' derived from the Greek work ekstriphein, which literally means 'turn inside out,' was first used by Chaussier in 1780. Martinez-Frias et al. (2001) emphasized that exstrophy of the cloaca and exstrophy of the bladder are 2 different expressions of a primary developmental field defect. Cloacal exstrophy is a feature of the OEIS (omphalocele-exstrophy-imperforate anus-spinal defects) complex (258040). Exstrophy of the cloaca includes the persistence and exstrophy of a common cloaca that receives ureters, ileum, and a rudimentary hindgut and is associated with failure of fusion of the genital tubercles and pubic rami, incomplete development of the lumbosacral vertebrae with spinal dysraphism, imperforate anus, cryptorchidism and epispadias in males and anomalies of the mullerian duct derivatives in females, and a wide range of urinary tract anomalies. Omphalocele is common, and most patients have a single umbilical artery. (600057)

Wikipedia : ⁷⁴ Bladder exstrophy is a congenital anomaly that exists along the spectrum of the exstrophy-epispadias... more...

Clinical features from OMIM:

600057

Search NIH Clinical Center for Exstrophy of Bladder

Search GEO for disease gene expression data for Exstrophy of Bladder.