Covered exstrophy of the bladder, approaches to treatment

Introduction. Classic bladder exstrophy is a rare anomaly, occurring in a ratio of 1:30000 to 1:50000 newborns. However, various variants of the exstrophy-epispadias complex are 10 times less common. Covered bladder exstrophy is a rare variant of classic exstrophy. Patients with the covered variant of exstrophy can be considered as classic exstrophy with all the accompanying defects of this anomaly, but with a bladder that is closed and covered only by a thin, often translucent skin membrane without muscles or a fascial layer. Cases in this category of patients may be underestimated in terms of the size of the defect at initial detection.

Case report. The article describes two rare clinical observations of treatment of children with covered bladder exstrophy. A 5-year-old boy underwent a full range of surgical treatment: primary closure of the bladder, Cohen ureterocystoneoimplantation, bladder neck plastic surgery, bilateral iliac osteotomy, with reduction and fixation of the pubic bones. A 10-year-old girl underwent plastic surgery of the anterior abdominal wall, bilateral iliac osteotomy, and reduction (convergence) of the pubic bones.

Conclusions. It is important to follow the principles of classical exstrophy correction in the treatment of children with covered bladder exstrophy. In the presence of symptoms of urinary incontinence, bladder neck reconstruction is indicated, this will improve continence and promote adequate bladder growth. Correct treatment of these malformations of the genitourinary system can significantly improve the quality of life of these patients.