Mesane Ve Genital Anomalisi Nedeni ile Değerlendirilen Erkek Yenidoğan
Özet
Bu olgu sunumunda, 22. gestasyonel haftada rutin fetal ultrasonografide anomali ön tanısı alan ve 39. haftada sezaryenle doğan bir erkek yenidoğanda saptanan klasik mesane ekstrofisi vakası ele alınmaktadır. Fizik muayenesinde karın ön duvarı ile mesane ön duvarının tamamen açık olduğu, penisin kısa ve üretranın açık olduğu saptanmıştır. 20.000-33.000 canlı doğumda bir görülen bu kompleks anomalide cerrahi öncesi mesane mukozasının nemli tutularak korunması büyük önem taşır. Olguya postnatal 3. saatte bilateral üreteroneosistostomi, mesane boynu onarımı ve primer kapatma uygulanmış; 18 aylıkken ise epispadias onarımı başarıyla tamamlanmıştır. Tedavi sürecinde ve sonrasında fistül, reflü, enfeksiyon ve fıtık gibi komplikasyonlar gelişebilmektedir.
This case report presents a male newborn diagnosed with classical bladder exstrophy, suspected during routine fetal ultrasonography at the 22nd gestational week and delivered via cesarean section at the 39th week. Physical examination revealed a completely open anterior abdominal and bladder wall, a short penis, and an open urethra. In this complex anomaly, occurring in 1 in 20,000-33,000 live births, keeping the bladder mucosa moist to protect it prior to surgery is crucial. The patient underwent bilateral ureteroneocystostomy, bladder neck reconstruction, and primary closure at the 3rd postnatal hour, followed by successful epispadias repair at 18 months of age. Complications such as fistulas, reflux, infections, and hernias may develop during and after treatment.
Referanslar
Docimo SG. The Kelalis--King--Belman Textbook of Clinical Pediatric Urology. CRC Press; 2018. doi:10.1201/9781315113982
Clinical manifestations and initial management of infants with bladder exstrophy - UpToDate. Accessed June 6, 2022. https://www.uptodate.com/contents/clinical-manifestations-and-initial-management-of-infants-with-bladderexstrophy?search=exstrophy%20vesica&source=search_result&selectedTitle=1~30&usage_type=default&display_rank=1
Gearhart JP, Jeffs RD. State-of-the-Art Reconstructive Surgery for Bladder Exstrophy at The Johns Hopkins Hospital. American Journal of Diseases of Children. 1989;143(12):1475-1478. doi:10.1001/ARCHPEDI.1989.02150240097026
Grady RW, Mitchell ME. Newborn exstrophy closure and epispadias repair. World J Urol. 1998;16(3):200-204. doi:10.1007/S003450050053
Lepor H, Shapiro E, Jeffs RD. Urethral reconstruction in boys with classical bladder exstrophy. J Urol. 1984;131(3):512-515. doi:10.1016/S0022-5347(17)50471-1
Diseth TH, Bjordal R, Schultz A, Stange M, Emblem R. Somatic function, mental health and psychosocial functioning in 22 adolescents with bladder exstrophy and epispadias. J Urol. 1998;159(5):1684-1690. doi:10.1097/00005392-199805000-00092
Surgical management and postoperative outcome of children with bladder exstrophy - UpToDate. Accessed June 6, 2022. https://www.uptodate.com/contents/surgical-management-and-postoperative-outcome-of-children-with-bladder-exstrophy?search=exstrophy%20vesica&source=search_result&selectedTitle=2~30&usage_type=default&display_rank=2
Lee T, Vasquez E, Logvinenko T, et al. Timing of inguinal hernia following complete primary repair of bladder exstrophy. Journal of Pediatric Urology. 2021;17(1):87.e1-87.e6. doi:10.1016/J.JPUROL.2020.11.025
Stein R, Stockle M, Fisch M, Nakai H, Muller SC, Hohenfellner R. The fate of the adult exstrophy patient. J Urol. 1994;152(5 Pt 1):1413-1416. doi:10.1016/S0022-5347(17)32433-3
Mathews RI, Gan M, Gearhart JP. Urogynaecological and obstetric issues in women with the exstrophy-epispadias complex. BJU Int. 2003;91(9):845-849. doi:10.1046/J.1464410X.2003.04244.X
