We are an international Center of Excellence in bladder and cloacal exstrophy
The Puigvert Foundation is the only accredited center in Europe.
The Puigvert Foundation has been recognized as an international Center of Excellence in bladder and cloacal exstrophy by theAssociation for the Bladder Exstrophy Community (A BE-C).
This distinction places us alongside the best centers in the world and confirms our leadership in care and support of patients, children and families who live with this complex minority pathology.
Bladder exstrophy
Bladder exstrophy It is a rare, very rare congenital malformation, where the urinary bladder and genitals do not close properly during fetal development, remaining exposed outside the abdomen at the time of birth.
The epidemiology shown by the European Society of Paediatric Urology indicates an estimated incidence of between 1 in every 40.000-71.000 live births, affecting boys at a rate approximately double that of girls.
Cloacal exstrophy
Cloacal exstrophy It is the most severe form of the vesicalepispadias exstrophy complex, where, in addition to the bladder, part of the intestines is also exposed.
It can be associated with other malformations such as spina bifida, genital and orthopedic malformations, and other effects on the kidneys and spine.
Epispadias
Epispadias is a rare birth defect in which the urethra opens in an abnormal position on the top of the penis in boys or very close to the clitoris in girls. It can affect urinary continence, the appearance of the genitals, and, in some cases, sexual function. This malformation can occur in isolation or be part of a more complex condition, such as bladder exstrophy or cloacal exstrophy.
Common complications include:
Urinary incontinence, as children cannot hold their urine.
Greater risk of urinary infections, kidney and digestive problems, and difficulties in sexual or reproductive function in adulthood.
It requires several surgical interventions during childhood and multidisciplinary monitoring.
Pediatric Urology Unit: a pioneering approach
Head of the Unit
Pediatric Urology
Dr. Anna Bujons Tur
The Pediatric Urology Unit of the Puigvert Foundation is led by Dr. Anna Bujons, an international reference in congenital urogenital malformations and highly complex surgical treatments. Dr. Bujons is a Doctor Cum Laude in Medicine and Surgery, a specialist in Urology and with a consolidated career in the management of pathologies such as bladder exstrophy, cloacal exstrophy, complex hypospadias and childhood urinary lithiasis.
The Unit's professionals are pioneers in clinical research, outreach and training, with active participation in innovative projects such as the use of stem cells for urinary reconstruction.
We respond to medical, emotional and social challenges leading to bladder and cloacal exstrophy:
Minimally invasive and robotic reconstructive surgery.
Comprehensive diagnosis and longitudinal follow-up, from prenatal diagnosis to adulthood.
Personalized surgical and medical treatment, with structured transition circuits to guarantee continuity of care in the adult stage.
Psychological support, genetic counseling, specialized nursing consultations and coordination with other hospital specialties.
Puigvert Foundation: the best specialized care.
50 years
of expertise
Integrated circuit
and multidisciplinary
Tracking
personalized
Collaboration with
Sant Pau – Campus
Health Barcelona
At Fundació Puigvert we have a long experience in caring for international patients, offering a specialized circuit and personalized coordination so that families from all over the world can access our treatments and expert monitoring with complete confidence and comfort.
Surgical reconstruction involves several interventions to close the bladder, correct the position of the urethra and treat 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, since they do not have a urinary sphincter or continence mechanism at birth, preserving renal function and genital appearance. As they grow, they require other treatments to improve continence, for example. It should be borne in mind that monitoring and control are necessary at different stages of life, and this aspect is fundamental.
At the Puigvert Foundation we carry out a comprehensive and lifelong approach, incorporating, according to your needs, the necessary professionals to address gynecological, sexuality, digestive aspects... In other words, a multidisciplinary team is needed.
Common complications include:
- Persistent or partial urinary incontinence
- Need for repeated interventions to reconstruct the bladder, urethra and genitals
- Increased risk of urinary tract infections and progressive deterioration of kidney function
- Orthopedic (pubic separation) and digestive alterations, especially in cloacal forms
With adequate monitoring and access to specialized treatments, most children with exstrophy can have an active life, attend school and integrate normally. Psychological support and social accompaniment are key to adaptation and self-esteem.
Yes. Cloacal exstrophy is more complex: it may require more interventions and the participation of other specialties (digestive, orthopedics, neurology) since 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 by gender to adapt to genitourinary anatomy and future continence, sexuality, or fertility needs.
Most cases are diagnosed through prenatal ultrasound in the third trimester of pregnancy, allowing for planning of delivery and initial intervention. Prevention is not yet possible, as it is a congenital disorder 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 catheterization to empty the bladder and prevent infections.
Long-term follow-up is essential, and at the Puigvert Foundation we integrate and manage 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 the adult stage to preserve renal function, continence and quality of life.
Depending on the needs of each case, gynecology, functional urology and pelvic floor rehabilitation, digestive, reconstructive and plastic surgery and andrology also intervene, forming a multidisciplinary team that guarantees complete and personalized care.
Yes. We are the only center of excellence in Spain accredited by the A-BE-C and the XUEC, CSUR and eUROGEN networks, with national and international coverage.
REQUEST AN APPOINTMENT
Do you want to consult your case with our expert team in bladder and cloacal exstrophy?
Request an appointment for a personalized evaluation or to resolve any questions about your diagnosis, treatment or follow-up. We accompany you throughout the process, with comprehensive and multidisciplinary care.
Private tour scheduling:
From Monday to Thursday, from 8am to 20pm
Friday, from 8am to 18pm
Center authorized by the Department of Health of the Generalitat de Catalunya with Registration No. H08000498.
Center registered in the Register of Foundations of the Generalitat de Catalunya with number 93
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