Rinus Wiersma1. 1. Department of Paediatric Surgery, University of KwaZulu-Natal, Congella 4013, KwaZulu-Natal, Durban, South Africa. rinuswie@ialch.co.za
Abstract
INTRODUCTION: Bladder exstrophy is an uncommon condition, and the ramifications for patients living in a Third World environment are extensive. PATIENTS AND METHODS: This was a retrospective study of 57 patients, managed between 1983 and 2006. The review looked at the home environment, clinical findings, treatment provided, and short-term outcome. RESULTS: Of the 57 patients, 19 were born in metropolitan and 38 in rural hospitals. Twenty-four patients (42%) were referred on the first day of life, 21 (37%) within the first week, and 12 patients (21%) were older than 1 week of life. Associated congenital anomalies were seen in 18 patients (32%). Twelve patients died in hospital, the remaining 45 were discharged. Thirty three patients returned for review; their ages ranged from 2 to 17 years (median, 3 years). The overall mortality was 42%. On follow-up, urinary incontinence was the main complaint, which greatly affected the child's schooling and social life. CONCLUSION: Bladder exstrophy is an uncommon condition. The associated congenital abnormalities together with the impoverished environment result in a poor prognosis. Antenatal screening, early referral, and establishing urinary continence are factors that will improve the outcome in children with this condition in a Third World environment.
INTRODUCTION:Bladder exstrophy is an uncommon condition, and the ramifications for patients living in a Third World environment are extensive. PATIENTS AND METHODS: This was a retrospective study of 57 patients, managed between 1983 and 2006. The review looked at the home environment, clinical findings, treatment provided, and short-term outcome. RESULTS: Of the 57 patients, 19 were born in metropolitan and 38 in rural hospitals. Twenty-four patients (42%) were referred on the first day of life, 21 (37%) within the first week, and 12 patients (21%) were older than 1 week of life. Associated congenital anomalies were seen in 18 patients (32%). Twelve patients died in hospital, the remaining 45 were discharged. Thirty three patients returned for review; their ages ranged from 2 to 17 years (median, 3 years). The overall mortality was 42%. On follow-up, urinary incontinence was the main complaint, which greatly affected the child's schooling and social life. CONCLUSION:Bladder exstrophy is an uncommon condition. The associated congenital abnormalities together with the impoverished environment result in a poor prognosis. Antenatal screening, early referral, and establishing urinary continence are factors that will improve the outcome in children with this condition in a Third World environment.
Authors: Antonio Zaccara; Mario De Gennaro; Antonio Di Lazzaro; Irma Capolupo; Patrizia Bozza; Angela Ragni; Pietro Bagolan Journal: Pediatr Surg Int Date: 2010-10-26 Impact factor: 1.827