Exstrophy of the bladder and associated anomalies

Bladder exstrophy is a rare malformation of the urogenital tract. Its incidence is about one per 25,000-40,000 births, with a two to one ratio of males over females. No hereditary factors have been established, and it has been stated in the literature repeatedly that this defect does not occur with an increased frequency in the same family. However, Higgins reports bladder exstrophy in twins on two accasions, and twice in brothers and sisters. Further histologic studies and long term follow up of patients whose bladders are turned in, are indicated. The significant histologic changes demonstrable in all exstrophic bladders which include the development of cancer, even after vesicoplasty, suggest that all such bladders should be excised.