Is your baby's bladder protruding? Let's talk about Bladder Exstrophy!

When a mother or father looks at a newborn baby, they expect to see a healthy, complete child. But imagine, what if you see a baby's bladder protruding from the skin on their belly? It's a truly heartbreaking and frightening sight. This is what we call Bladder Exstrophy in medicine. It's perfectly reasonable to be scared and worried when you see this. But the most important thing is that there is a successful treatment for this. So let's talk about everything clearly and simply.

Simply put, what is Bladder Exstrophy?

Bladder exstrophy is a rare congenital condition. Normally, when a baby is growing in the womb, the internal organs, including the bladder, develop inside the body. However, in this condition, the baby's bladder develops outside the body, exposed to the skin in the lower abdomen.

In this situation, this is what happens:

• The skin and pelvic bones in the lower abdomen do not connect properly.
• Therefore, the bladder is visible through the skin of the abdomen.
• The bladder, which should normally be like a balloon, in this case has a flat shape.
• As a result, the bladder cannot hold urine or function normally. Urine continues to leak out.

How does this condition affect the baby's body?

Let's look at how the urinary system normally works. When your bladder fills with urine, a signal is sent from the nervous system to the brain that says, "The bladder is now full." Then the muscles in the bladder contract (contract), and urine is expelled through the urethra.

But this process doesn't happen in a baby with Bladder Exstrophy. Because the baby's bladder is outside, there's no place for urine to collect. So the urine produced by the kidneys flows directly out through this open bladder in the abdomen.

Are there different types of Bladder Exstrophy?

Yes, Bladder Exstrophy is a condition that belongs to a group of birth defects called Bladder Exstrophy-Epispadias Complex (BEEC). Some children may have only one of these conditions, while others may have several of these conditions together.

Is this situation common?

No, Bladder Exstrophy is a very rare condition. It affects only one in 50,000 newborns.

What are the main symptoms?

The main and most obvious symptom is the bladder protruding from the abdomen. In addition, several other symptoms can be seen.

• The belly button is located much lower than normal.
• The pubic bones are not connected, but instead are located apart.
• The anus may be located further forward than normal.
• In boys , the testicles may not have descended into the scrotum (undescended testicles).
• Some children may also develop hernias , such as inguinal hernias or umbilical hernias.

What are the causes and risk factors for this?

The exact cause of this condition is not yet known , but doctors believe that a combination of genetic and environmental factors may play a role. It is important to understand that there is no fault on the part of the parents to cause this condition.

Here are some of the risk factors that have been identified:

• Family history: If one of the parents had this condition as a child, their child has about a 1 in 70 chance of developing it.
• Race: This condition has been found to be quite common among white people.
• Gender: Boys are about three times more likely to develop this condition than girls.
• Fertility treatments: Some studies show that using methods such as Assisted Reproductive Technology (IVF) may slightly increase this risk.

What is the treatment and outlook like?

A baby with Bladder Exstrophy will definitely need surgery . This is the only treatment. Depending on the severity of the baby's condition, the condition can be completely corrected with one or more surgeries.

There are generally two ways in which surgery is performed:

1. Single surgery: In some cases, the stomach is closed and the urethra is repaired in a single surgery performed within the first few months after the baby is born.

2. Three-stage surgery: This is the method most often performed.

• First stage (postpartum): Within a few days of birth, the baby's bladder is placed inside the body and the abdomen is closed. At the same time, an operation (`osteotomy`) is performed to bring the pelvic bones, which are far apart, together.
• Stage 2 (around 6 months): This surgery (epispadias repair) reconstructs the reproductive organs and urethra.
• Stage 3 (around 4-5 years): By now the child is at the age of toilet training. This surgery (`augmentation cystoplasty`) is performed to make the bladder larger enough to hold urine.

Possible long-term complications

Even after treatment, some children may develop bladder or kidney problems.

• Kidney infection (pyelonephritis)
• Kidney stones
• The risk of developing bladder cancer is slightly higher later in life.
• Problems related to sexual function.

Women with this condition are considered to have a high-risk pregnancy , and often require a cesarean section (C-section) to deliver the baby. Men may need assisted reproductive techniques such as in vitro fertilization (IVF) to have children.

How you feel as a parent

Finding out that your child has a congenital condition is a difficult thing for any parent to deal with. You may feel scared, anxious, and guilty. All of these feelings are very normal.

But remember, this is not your fault . Even doctors can't say for sure why Bladder Exstrophy occurs. Give yourself some time to understand and adjust to this condition. Treatments are very effective. This condition will not prevent your child from having a normal childhood. Doctors understand your feelings very well. They are there to support and advise you every step of the way. So don't be afraid to talk to your doctor about everything.

Bladder Exstrophy, Bladder protrusion, Birth defects, Baby's bladder, epispadias, Surgery, Pediatrics