Theodore H. Sweetser

Care of the child with exstrophy of the bladder.

ORTUNATELY, only about one out of every 40,000 babies is born with the distressing anomaly known as exstrophy of the bladder. In this anomaly, the lower abdominal wall and the anterior wall of the urinary bladder and urethra have failed to close and the child is born with an incompletely formed bladder which has extruded through the opening of the abdomen. The mucosa of the bladder is exposed. Frequently the openings of the ureters can be seen on the posterior wall of the bladder, and urine drains constantly from them across the exposed surface. The diagnosis is, of course, obvious but, as is so often true when one congenital defect is present, others may occur. The obstetrician, the nurse, and the pediatrician should search for associated anomalies such as hernias, bifid scrotum or clitoris, imperforate anus, a congenital defect of the heart, or a cleft lip and palate. The family must be helped to understand and to accept, from the very beginning, the fact that their baby has a very serious defect and that constructive plans need to be made for the future. Responsibility for this explanation rests primarily with the pediatrician, who can offer a factual explanation of the developmental defect, with a prognosis that will depend on the babys general condition and on the known facilities for correction of such a defect. The nurse, who will spend much more time with the mother of this newborn baby than will the doctor, needs to know what the mother has been told so that she, the nurse, will be able to give supporting rather than conflicting information if the mother wishes to talk with her. The amount of emotional support that can be given will depend on the needs of the mother, the ability of the nurse to recognize what she herself can offer, or from what other sources-family, professional, religious-support can be sought. Eventually the family-with the help of the pediatrician and consultants-must decide as to the treatment of the child with the exstrophied bladder. Most pediatricians, and indeed most urologists, are accustomed to the concept that surgical restoration of an exstrophied bladder to a near normal state is not possible. Numer-