What is bladder exstrophy, cloacal exstrophy, and epispadias?

Surgical reconstruction involves several interventions to close the bladder, correct the position of the urethra, and address the anatomy of the genitals and pubis. It often begins in the neonatal period and requires more surgeries during childhood and adolescence to improve urinary continence, as they are born without a urinary sphincter or continence mechanism, preserve renal function, and the genital appearance. As they grow, they require other treatments to improve continence, for example. It is important to note that follow-up and monitoring are necessary at different stages of life, and this aspect is fundamental.

At Fundació Puigvert, we take an integrated and lifelong approach, incorporating, according to their needs, the necessary professionals to address gynecological, sexual, digestive aspects… That is, a multidisciplinary team is required.

Common complications include:

• Persistent or partial urinary incontinence
• Need for repeated interventions to reconstruct the bladder, urethra, and genitals
• Increased risk of urinary infections and progressive deterioration of renal function
• Orthopedic (pubic separation) and digestive alterations, especially in cloacal forms

With proper follow-up and access to specialized treatments, most children with exstrophy can lead an active, educated life and integrate normally. Psychological support and social accompaniment are key for adaptation and self-esteem.

Yes. Cloacal exstrophy is more complex: it may require more interventions and the involvement of other specialties (digestive, orthopedics, neurology) as it affects different organs in addition to the bladder. It may be associated with spina bifida and anomalies in the kidneys, genitals, spine, or anus.

The basic approach is similar, but the surgical approach may vary according to sex to adapt to the genitourinary anatomy and future needs for continence, sexuality, or fertility.

Most cases are diagnosed through prenatal ultrasound in the third trimester of pregnancy, allowing for planning of delivery and initial intervention. Prevention is still not possible, as it is a congenital alteration of unknown origin.

Depending on the case and the results of the reconstruction, some patients will maintain the ability to urinate spontaneously, but others may require intermittent catheterizations to empty the bladder and avoid infections.

Long-term follow-up is essential, and at Fundació Puigvert, we integrate and direct it globally, offering a lifelong program that accompanies each person from birth to adulthood. It includes periodic check-ups with pediatric urology, nephrology, psychology, and rehabilitation, and a structured transition to specialized units in adulthood to preserve renal function, continence, and quality of life.

Depending on the needs of each case, gynecology, functional urology, pelvic floor rehabilitation, digestive, reconstructive and plastic surgery, and andrology also intervene, forming a multidisciplinary team that ensures comprehensive and personalized care.

Yes. We are the only center of excellence in Spain accredited by A-BE-C and the networks XUEC, CSUR, and eUROGEN, with state and international coverage.