Corrected Bladder Exstrophy and Successful Pregnancy: A Case Report

Bladder exstrophy (BE) is a rare congenital anomaly that presents significant challenges for affected individuals, particularly women of reproductive age. This case report highlights the successful pregnancy outcome in a patient with surgically corrected bladder exstrophy.

Case Presentation

We present the case of a 26-year-old primigravida with a history of congenital bladder exstrophy. The patient had undergone multiple reconstructive surgeries:

• Three bladder surgeries since birth
• Suprapubic catheter for 15 years
• Vaginoplasty for vaginal atresia three years prior
• Two vaginal dilatation procedures

Pregnancy Course

The patient presented at 20 weeks gestation with a viable intrauterine pregnancy. Notable findings during pregnancy included:

• Bilateral hydronephrosis and hydroureter
• Pyelonephritis at 32 weeks requiring IV antibiotics
• Preterm rupture of membranes at 33 weeks

Delivery and Outcome

An emergency cesarean section was performed via a midline classical incision to avoid disrupting previous urological repairs. The patient delivered a live female infant weighing 1.4kg with Apgar scores of 6/8/9. The baby did well despite prematurity and was discharged at 1.80kg.

Discussion

Bladder exstrophy is a complex genitourinary malformation with an incidence of 1:30,000 to 1:50,000 live births. Key considerations in pregnancy include:

• Renal abnormalities present in 60% of patients
• Increased risk of urinary tract infections
• Potential for uterine prolapse due to pelvic floor abnormalities
• Cesarean delivery is typically recommended to protect reconstructed anatomy

Conclusion

This case demonstrates that with appropriate multidisciplinary care, women with corrected bladder exstrophy can achieve successful pregnancy outcomes. Key factors for success include:

• Preconception counseling and evaluation
• Close antenatal monitoring
• Planned cesarean delivery with careful consideration of surgical approach
• Collaboration between obstetricians and urologists

This case provides hope and valuable clinical insights for other women with similar conditions contemplating pregnancy.