What is the pathophysiology of bladder exstrophy?

Updated: Nov 05, 2019
  • Author: James G Glasser, MD, MA, FACS; Chief Editor: Dharmendra J Nimavat, MD, FAAP  more...
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Answer

The bladder develops between the fifth and ninth gestational weeks (postfertilization). [13] By 10 weeks, urine is produced and mixes with the amniotic fluid; this is crucial for normal lung development.

In healthy infants, the bladder is visible on ultrasonography toward the end of the first trimester. In these patients, the bladder is open with exposed mucosa, forming a protruding disc below the umbilical cord, which is displaced caudally. The pelvic rami are spread apart; consequently, the pelvis is shallow and lacks depth. Hence, the developing bladder, urethra, vagina, and rectum are displaced anteriorly. The abnormal position of these organs interferes with normal development of the lower abdominal wall. (See the images below.)

Pediatric omphalocele and gastroschisis (abdominal Pediatric omphalocele and gastroschisis (abdominal wall defects). Bladder exstrophy and epispadias is shown in an infant. Note the appearance of the bladder mucosa, indicating chronic inflammation.
Pediatric omphalocele and gastroschisis (abdominal Pediatric omphalocele and gastroschisis (abdominal wall defects). This is another view demonstrating the epispadias shown in the previous image.

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