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Diagnosis of epispadias and bladder exstrophy
Last reviewed: 04.07.2025
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Conventional ultrasound diagnostics of the fetus allows to detect exstrophy of the urinary bladder in the early stages of pregnancy. Only the extreme rarity of this anomaly and the lack of special caution make prenatal diagnostics of exstrophy of the urinary bladder difficult in our country. An ultrasound diagnostic specialist must see a full urinary bladder of the fetus at least once during the observation of the pregnant woman. The absence of a normal urinary bladder on ultrasound in combination with a formation in the abdominal wall with a low navel indicates the presence of exstrophy. A thorough examination of the site of departure of the umbilical cord helps to conduct differential diagnostics between exstrophy of the urinary bladder, umbilical cord hernia and gastroschisis.
The diagnosis of bladder exstrophy is usually made immediately after the birth of the child. The manifestations of the pathology are very bright, and with classic bladder exstrophy, the diagnosis is obvious. However, since this anomaly is relatively rare, then identifying the sex and determining the localization of organs such as the vagina, clitoris, rudimentary penis, usually require examination and examination of the child by a specialist.
Associated anomalies in patients with classic bladder exstrophy are rare, however, special attention should be paid to the examination of the heart, lungs, and lumbar spine.
The prognosis of the disease and the effectiveness of subsequent bladder growth and the ability to retain urine depend partly on the size of the bladder area. It is important to determine the length and width of the bladder area, assess the condition of the bladder mucosa, especially if the child is not a newborn. If a plastic clamp is applied to the remainder of the umbilical cord, it should be removed and replaced with a ligature. It is better to cover the bladder with perforated polyethylene film, and only then with a diaper or nappies. Gauze and petroleum jelly should never be used, as they dry out and injure the epithelium of the bladder mucosa.
In boys, the penis size should be measured. The genital malformation can range from relatively mild in epispadias to severe in cloacal exstrophy. It is important to palpate the testicles. They can be located in the scrotum or in the inguinal canal. Cryptorchidism is rarely detected. If an inguinal hernia is present, it is necessary to diagnose epispadias and bladder exstrophy. In girls, one or two vaginal openings are usually detected, which are located directly under the open urethra.
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