Exstrophy of the Bladder

  1. General information
    1. Congenital malformation in which nonfusion of abdominal and anterior walls of the bladder during embryologic development causes anterior surface of bladder to lie open on abdominal wall
    2. Varying degrees of defect
  2. Assessment findings
    1. Associated structural changes
      1. Prolapsed rectum
      2. Inguinal hernia
      3. Widely split symphysis
      4. Rotated hips
    2. Associated anomalies
      1. Epispadias
      2. Cleft scrotum or clitoris
      3. Undescended testicles
      4. Chordee (downward deflection of the penis)
  3. Medical management: two-stage reconstructive surgery, possibly with urinary diversion; usually delayed until age 3-6 months
  4. Nursing interventions: preoperative
    1. Provide bladder care; prevent infection.
      1. Keep area as clean as possible; urine on skin will cause irritation and ulceration.
      2. Change diaper frequently; keep diaper loose fitting.
      3. Wash with mild soap and water.
      4. Cover exposed bladder with Vaseline gauze.
  5. Nursing interventions: postoperative
    1. Design play activities to foster toddler's need for autonomy (e.g., Play-Doh, talking toys, books); child will be immobilized for extended period of time.
    2. Prevent trauma; as child gets older and more mobile, trauma more likely; teach parents to avoid areas such as sandboxes.