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Analyzing the factors that contribute to the development of embryological classical type of bladder exstrophy

  • Ria Margiana (Andrology Program, Faculty of Medicine, Airlangga University) ;
  • Widya Juwita (Andrology Program, Faculty of Medicine, Airlangga University) ;
  • Khoirul Ima (Biomedical Sciences, Faculty of Medicine, University of Indonesia) ;
  • Zakiyatul Faizah (Andrology Program, Faculty of Medicine, Airlangga University) ;
  • Supardi Supardi (Andrology Program, Faculty of Medicine, Airlangga University)
  • Received : 2023.02.28
  • Accepted : 2023.06.18
  • Published : 2023.12.31

Abstract

Bladder exstrophy is a rare congenital condition of the pelvis, bladder, and lower abdomen that opens the bladder against the abdominal wall, produces aberrant growth, short penis, upward curvature during erection, wide penis, and undescended testes. Exstrophy affects 1/30,000 newborns. The bladder opens against the abdominal wall in bladder exstrophy, a rare genitourinary condition. This study is vital to provide appropriate therapy choices as a basis to improve patient outcomes. This study may explain bladder exstrophy and provide treatment. Epispadias, secretory placenta, cloacal exstrophy, and other embryonic abnormalities comprise the exstrophy-spades complex. The mesenchymal layer does not migrate from the ectoderm and endoderm layers in the first trimester, affecting the cloacal membrane. Embryological problems define the exstrophy-aspidistra complex, which resembles epimedium, classic bladder, cloacal exstrophy, and other diseases. Urogenital ventral body wall anomalies expose the bladder mucosa, causing bladder exstrophy. Genetic mutations in the Hedgehog cascade pathway, Wnt signal, FGF, BMP4, Alx4, Gli3, and ISL1 cause ventral body wall closure and urinary bladder failure. External factors such as high maternal age, smoking moms, and high maternal body mass index have also been associated to bladder exstrophy. Valproic acid increases bladder exstrophy risk; chemicals and pollutants during pregnancy may increase bladder exstrophy risk. Bladder exstrophy has no identified cause despite these risk factors. Exstrophy reconstruction seals the bladder, improves bowel function, reconstructs the vaginal region, and restores urination.

Keywords

Acknowledgement

Special gratitude is extended to the consultant and resident of the Study Program of Andrology at the Faculty of Medicine at Universitas Airlangga, as well as the anatomy staff of the Department of Anatomy at the Faculty of Medicine at Universitas Indonesia, for their assistance in providing advice when this paper was being written.

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