Bladder and Cloacal Exstrophy

Bladder exstrophy is a rare condition, resulting from a failure of fusion of midline tissues at the lower abdominal region (including the anterior urogenital elements), wherein the inner surface of the urethra and posterior bladder wall are exposed anteriorly, associated with bilateral hemipelvic posterolateral rotation, a substantial pubic diastasis, and a deficient lower abdominal wall. The goals of treatment include a successful primary closure and the eventual achievement of urinary continence. Successful and sustained urogenital reconstruction is dependent on a tension-free closure of the anterior soft tissues, facilitated by pelvic osteotomies, to avoid wound dehiscence and need for revision surgery. This chapter will offer a comprehensive review of the associated musculoskeletal and urogenital pathoanatomy, clinical aspects and natural history, for both classic bladder exstrophy and cloacal exstrophy, as well as a description of pelvic osteotomy techniques. A brief overview of the principles of urogenital reconstruction in bladder exstrophy will also be covered.