Squamous cell carcinoma in bladder exstrophy: a rare entity.
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Carcinomas arising from an exstrophic urinary bladder are rare entities, and only seven such cases have been reported in the literature. We present the eighth case of advanced squamous cell carcinoma arising from an exstrophic bladder, with a pertinent review of the literature. The mean age of the patients was 54.9 years, with a male to female ratio of 3:1. The average duration of symptoms was 18.6 months. The appearance of a new growth was the most common symptom. Three patients had stage I disease, one patient each had stage II and III disease, two patients had stage IV disease, and the disease stage was not known in one patient. Five out of these eight patients underwent surgery. Four patients in the treatment group remained disease-free, with a mean survival period of 30 months. In conclusion, regular surveillance with cystoscopy is advised in all cases that had primary closure of the exstrophic bladder. (+info)
Insertion/deletion polymorphisms in the DeltaNp63 promoter are a risk factor for bladder exstrophy epispadias complex.
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Deciphering caudal embryonic defects: embryological analysis and reviewing literature data.
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BACKGROUND: A number of syndromes/associations involving the caudal region have been described in the literature. Each of them is characterized by a set of morphological features. Reports on difficulties in delineation and an ever-increasing constellation of defects in recent past call for a comprehensive study into the morphologic presentations and pathogenesis of caudal embryonic defects. MATERIALS AND METHODS: The present article describes a case of the OEIS complex--a combination of omphalocele, exstrophy of bladder, imperforate anus and spinal defects. Literature search was performed and morphologic presentations, as described in literature, of all syndromes and associations affecting the caudal region of the embryo have been compared. Morphologic presentations were analyzed embryologically. RESULTS: A remarkable overlap of symptom complex was observed. Embryological analysis of the phenotypic presentations of all these syndromes points towards a common pathogenesis, early in the embryonic life. The embryologic analysis suggests that these defects are a result of defects in proliferation, migration or subsequent differentiation of any of the three subdivisions of intra-embryonic mesoderm. CONCLUSIONS: Based on the analysis a new hypothesis for the causation of caudal defects is proposed. This hypothesis suggests that a local internal environmental imbalance, at the site of implantation, can cause nutritional insult to the embryo during gastrulation, during the third and the early fourth week of embryonic life. (+info)
Comparison of musculoskeletal anatomic relationships, determined by magnetic resonance imaging, in postpubertal female patients with and without classic bladder exstrophy.
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Adjustable male sling: our experiences with placement of adjustable male sling, including a case of exstrophy-epispadias: initial report.
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PURPOSE: To present our experience of using an adjustable male sling, Argus(R) (Promedone SA; Cordoba, Argentina), in patients with stress urinary incontinence (SUI), and report its success, extension of indications, and management of complications. MATERIALS AND METHODS: We retrospectively evaluated Argus implantation results in 17 patients, including 15 post prostatectomy incontinence, one exstrophy-epispadias, and one neurogenic bladder patient. Of 17 patients, 12 had severe (more than 5 pads daily) and 5 had moderate SUI (2 to 5 pads daily). Seven patients had history of previous surgeries. Patients were evaluated pre-operatively with urodynamic study and cystoscopy. RESULTS: After median follow-up of 11.8 months (range, 3 to 22 months), 9 patients were continent, 7 had mild SUI (1 pad daily), and one had the device removed due to perineal and bladder symptoms. Argus adjustment was done in 10 out of 17 patients; 8 tightening and 2 loosening. In a totally incontinent exstrophy-epispadias patient with a history of multiple bladder surgeries, continence was achieved after device readjustment. In a patient with neurogenic bladder with a history of cystoplasty, severe SUI changed into a moderate sporadic SUI. In 2 patients, prosthesis infection occurred, which was managed with antibiotics without the need for Argus explantation. CONCLUSION: Argus is a simple and good device to control incontinence in men. It may also be used in exstrophy-epispadias patient who is not a candidate for urinary sphincter implantation. Infection complication may be managed conservatively. To the best of our knowledge, this is the first report of successful Argus implantation in exstrophy-epispadias patient. (+info)
Role of bulking agents in bladder exstrophy-epispadias complexes.
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