Spotting Questions - Bladder Exstrophy (3 Marks Each)

Q1. Identify the condition shown in the image and describe the three characteristic features visible. (3 marks)

• Diagnosis: Bladder Exstrophy (Ectopia Vesicae) - part of the Exstrophy-Epispadias Complex (1 mark)
• Feature 1: Exposed bright red posterior bladder mucosa on the lower abdominal wall - everted and lobulated (1 mark)
• Feature 2: Low-set umbilicus positioned immediately superior to the bladder defect (visible umbilical cord clamp) (0.5 mark)
• Feature 3: Bifid/split external genitalia (epispadias plate) due to separation of pubic symphysis (0.5 mark)

Q2. Name the condition and explain its embryological basis and one associated anomaly. (3 marks)

• Diagnosis: Bladder Exstrophy (1 mark)
• Embryological basis: Failure of mesoderm to migrate between the ectoderm and endoderm of the cloacal membrane during the 4th-5th week of development, causing the cloacal membrane to rupture prematurely and exposing the posterior bladder wall (1 mark)
• Associated anomaly (any one): Epispadias / widened pubic symphysis (diastasis pubis) / vesicoureteric reflux / inguinal hernia / undescended testis (1 mark)

Q3. What is the diagnosis? Mention two immediate neonatal complications and the principle of surgical management. (3 marks)

• Diagnosis: Bladder Exstrophy (1 mark)
• Immediate complications (any two): Trauma/infection of exposed bladder mucosa; urinary incontinence; squamous metaplasia of bladder mucosa from repeated trauma; ascending urinary tract infection (1 mark)
• Principle of surgical management: Primary bladder closure within 48-72 hours of birth (to prevent bladder mucosal damage), with staged repair including bladder neck reconstruction (modified Cantwell-Ransley repair or complete primary repair - Mitchell technique), epispadias repair, and pelvic osteotomy if pubic diastasis is significant (1 mark)