Bladder exstrophy - Causes, Symptoms and Treatment .MF .
bladder exstrophy - a severe congenital malformation, in which noted abdominal wall defect and loss of bladder mucosa outside.
Causes of bladder exstrophy
bladder exstrophy - this is not the most common disease in urology, but because it gives a very serious complications, its study in the clinic of urological diseases is mandatory.The only reason the factor of bladder exstrophy not.The development of disease is involved a lot of internal and external factors, which can be realized not every person.
First of all, pregnant women need to determine the level of hormones, as it dishormonal disorders often become causes of congenital anomalies.Diabetes mellitus, pituitary gland tumor, adrenal hyperplasia, hyperthyroidism - not all diseases that can be the cause of bladder exstrophy.
Among the external factors necessary to allocate smoking, drinking alcoholic beverages, embriotoksicskie infections, the effect of some chemical substances and medicines.In addition, in order to prevent the development of bl
great importance in the development of bladder exstrophy scientists assign a traumatic injury.In their view, the injury - it is the most frequent causative factor in the development not only exstrophy, but also a variety of other congenital anomalies of the urinary system.
Symptoms of bladder exstrophy
bladder exstrophy - a disease with a bright clinical symptoms.First of all, it is characterized by the absence of the anterior abdominal wall in the lower abdomen and the absence of the front wall of the bladder.Thus, the surface of the mucosa falls immediately posterior wall of the bladder.Naturally, in this case urine, which comes from the kidneys, are not allocated on the urethra and through the defect falls out.
Constant skin irritation around the defect of the bladder immediately causes its inflammation.Clinically it is characterized by redness and intense itching.But because the child is very small, itching of his skin appears deterioration of general condition, irritability, refusal of the breast and poor weight gain.
Talk about having to go to the urologist at such pathology is stupid because it is 100 percent of cases are diagnosed in the maternity ward, where the baby is sent to surgery in urological hospital.
diagnosis of bladder exstrophy
In connection with the characteristic clinical picture of the disease, diagnostic pathology is not much difficulty.However, to convince that it is a defect in the cavity of the bladder, rather than, say, in the stomach, it is necessary to do some additional research.First, you need to research released from the defect of the anterior abdominal wall.When extrophy bladder urine is released in assays that whereas when other pathologies may be found peritoneal fluid or serous exudate.
Very informative methods in this situation it is necessary to consider cystoscopy.The device in this case is not introduced through the urethra, and directly into the bladder wall defect.This allows us to estimate the size of the defect, as well as to determine its location in relation to other important anatomical structures, such as the opening of the ureter or urethra.
Because bladder exstrophy may be associated with other serious diseases of internal organs, a child needs to carry out a number of additional studies to identify the latter.For example, with the help of ultrasound can detect abnormalities such organs as kidneys, liver and spleen.In addition, used computed tomography and endoscopic examination.
It is imperative to carry out a genetic examination of the child, as bladder exstrophy can often be a symptom of a genetic disease, such as Down's syndrome or Edwards.Certainly better if this genetic analysis will be carried out during pregnancy.
exstrophy of the bladder Treatment
Naturally, this malformation lends itself exceptionally surgical correction.Plastic surgery, performed with bladder exstrophy is always very difficult and threatens fatal to the patient.It should be noted that in order to close abdominal wall defect in the child do not always have its own tissues, so it is necessary to apply a variety of operating techniques.
Classically, the first stage of surgery is to eliminate the defects of the bladder wall.Thereafter, if enough autologous tissue of the abdominal wall, and the latter is closed defect.If the hole in the abdomen is too large and can not be so pull the fabric to close it temporarily use sterile plastic film.
Surgical treatment of exstrophy
After some time, when the anterior abdominal wall will start to slightly cover the plastic film, a second surgery.In the last removes the plastic and pulling the skin and tissues in the abdominal wall defect.It should be noted that it is not always possible to perform the operation in two stages.Usually they can be much more.
After surgery and during the life of the synthetic implant is necessary to pursue an active antibiotic therapy, since there is a very high risk of secondary infection.As a rule, the children immediately appointed three groups of antibacterial agents.Most often, experts advise to use a combination of cephalosporins and fluoroquinolones, aminoglycosides.No dispensed at the pharmacy on prescription, and children are administered intravenously or intramuscularly in a hospital.
rehabilitation after illness
People born with similar birth defect require prophylactic treatment of urogenital system throughout life.They are encouraged to visit each year such as the mineral spas and Morshyn Glade.In addition, it is extremely important to periodically undergo a complete tool inspection at the urologist, because even after successful surgery, there may be a lot of long-term complications.
Feeding habits and lifestyle
lifelong prophylactic treatment applies to human nutrition.Such people are prohibited to eat salty, spicy and peppered foods.In addition, they are required to control their water regime, as excessive fluid consumption threatens the development of renal complications.
As for lifestyle, it primarily concerns the moment when the child is obliged to live with plastic film instead of the anterior abdominal wall.At this time, parents need to learn to properly care for the child.Implant itself, as such, special care is not needed, but it is necessary to prevent mechanical damage.If the child is restless, it must cover the belly soft blanket, so he could not hurt himself.Every day, you need to carefully inspect the anterior abdominal wall for fluid transmission.In identifying the slightest leak, you must immediately contact a urologist.As a rule, the defect persists without surgery, although quite often it becomes a cause of an unscheduled operation.
Treatment folk remedies
Because children with bladder exstrophy from birth do not leave the hospitals, they just physically can not fall into the hands of traditional healers.It is only good for them, because even scary to imagine what might happen to a child in need of immediate surgery, which fell into the hands of the sorcerer.
Complications of bladder exstrophy
number of complications of the disease depends on the time of surgery.First, doctors need to fear of hypothermia, that is, excessive heat loss.This occurs primarily because of the fact that the abdominal wall defect, devoid of skin is a very good conductor of heat.To prevent hypothermia during the first hours after the operation, the child should immediately shift to the incubator.This device, which is a glass cover, is able to maintain the necessary for the child's temperature and air humidity.
second dangers faced kid with exstrophy of the bladder immediately after birth are septic complications.The defect of the anterior abdominal wall - is the entrance gate to a pathogenic infection, which just completely in the hospital, the first dwelling place of a young patient.Therefore, all patients must be the first day after birth to start a course of antibiotic prophylaxis in order to avoid the development of peritonitis at first, and then sepsis.
addition, isolated and secondary complications that develop after surgery.First of all, this adhesive disease.Because of the large number of traumatic operations falling into the abdominal cavity huge amount of fibrin which eventually turns into a fibrous adhesions strands.This can lead to severe pain syndrome and intestinal obstruction in the future.
Prevention of bladder exstrophy
prevention of this disease need to be addressed before the child's birth.First of all, it must be a genetic consultation, which makes it possible to identify chromosomal abnormalities such as Down's syndrome or Edwards.Naturally, when making such a diagnosis, the most difficult task to be parents.They have to decide to keep the baby or not.
In addition, it is necessary to be surveyed on all embriotoksicskie infection.They include herpes, rubella, syphilis, toxoplasmosis and cytomegalovirus.If such diseases identified during pregnancy, the woman is necessary to register the respective course of treatment.At the same time, it must be ensured that during pregnancy does not succumb to the pathological effects such as smoking, alcohol and drugs.
Ed.urologist, sexologist-andrologist Plotnikov AN