Overview of bladder exstrophy: a third world perspective.
BACKGROUND
Bladder exstrophy is an uncommon condition, and the ramifications for patients living in a Third World environment are extensive.


METHODS
This was a retrospective study of 57 patients, managed between 1983 and 2006. The review looked at the home environment, clinical findings, treatment provided, and short-term outcome.


RESULTS
Of the 57 patients, 19 were born in metropolitan and 38 in rural hospitals. Twenty-four patients (42%) were referred on the first day of life, 21 (37%) within the first week, and 12 patients (21%) were older than 1 week of life. Associated congenital anomalies were seen in 18 patients (32%). Twelve patients died in hospital, the remaining 45 were discharged. Thirty three patients returned for review; their ages ranged from 2 to 17 years (median, 3 years). The overall mortality was 42%. On follow-up, urinary incontinence was the main complaint, which greatly affected the child's schooling and social life.


CONCLUSIONS
Bladder exstrophy is an uncommon condition. The associated congenital abnormalities together with the impoverished environment result in a poor prognosis. Antenatal screening, early referral, and establishing urinary continence are factors that will improve the outcome in children with this condition in a Third World environment.
Wiersma
Rinus
R
Department of Paediatric Surgery, University of KwaZulu-Natal, Congella 4013, KwaZulu-Natal, Durban, South Africa. rinuswie@ialch.co.za
D000293:Adolescent; D001746:Bladder Exstrophy / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012424:Rural Population; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D016019:Survival Analysis; D016896:Treatment Outcome; D014505:Urban Population; D014549:Urinary Incontinence / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D016476:Urinary Reservoirs, Continent