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Isolated bladder exstrophy in prenatal diagnosis.

Michael R Mallmann1,2, Birte Mack-Detlefsen3, Heiko Reutter4,5

  • 1Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany. michael.mallmann@uk-koeln.de.

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|May 23, 2019
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Summary

Prenatal ultrasound can diagnose classic bladder exstrophy (CBE), a rare condition. This study reviewed 12 cases, highlighting key ultrasound findings and outcomes for affected fetuses.

Keywords:
Bladder exstrophyFetusPrenatal diagnosis

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Area of Science:

  • Fetal Medicine
  • Pediatric Surgery
  • Medical Imaging

Background:

  • The bladder-exstrophy-epispadias complex (BEEC) is a spectrum of congenital anomalies.
  • Isolated classic bladder exstrophy (CBE) is the most common variant within the BEEC spectrum.
  • Prenatal diagnosis of CBE is challenging but crucial for management.

Purpose of the Study:

  • To report on a series of 12 prenatally diagnosed cases of isolated classic bladder exstrophy (CBE).
  • To illustrate the spectrum of prenatal ultrasound findings associated with CBE.
  • To compare findings with previously published reports on prenatal CBE diagnosis.

Main Methods:

  • Retrospective study of 12 fetuses diagnosed with CBE.
  • Data collected from two tertiary referral centers in Germany over a 14-year period (2004-2018).
  • Analysis of prenatal ultrasound findings, including gestational age at diagnosis and specific malformations.

Main Results:

  • Median diagnosis via ultrasound at 24 weeks + 5 days gestation.
  • Pathognomonic findings included non-visualization of the fetal bladder and a protruding abdominal mass.
  • Normal kidney anatomy and amniotic fluid were observed in all cases; epispadias was visible in 6/8 males. 11/12 fetuses were live born and underwent reconstructive surgery.

Conclusions:

  • Isolated classic bladder exstrophy (CBE) is an extremely rare prenatal sonographic finding.
  • Prenatal ultrasound is valuable for diagnosing CBE and its associated features.
  • Prenatal diagnostics must also exclude other cloacal malformations within the BEEC spectrum.