bladder exstrophy2bladder exstrophy

Bladder exstrophy (also known as Ectopia vesicae) is a congenital anomaly in which part of the urinary bladder is present outside the body. It is rare, occurring once every 10,000 to 50,000 live births with a 2:1 male:female ratio. The diagnosis involves a spectrum of anomalies of the lower abdominal wall, bladder, anterior bony pelvis, and external genitalia. It occurs due to failure of the abdominal wall to close during fetal development and results in protrusion of the anterior bladder wall through the lower abdominal wall.

Treatment is with surgical correction of the defect, but patients can still have long term issues with urinary tract infections and urinary incontinence.

Even with successful surgery, patients may have long-term problems with

  • incontinence
  • urinary reflux (see Vesicoureteral reflux)
  • repeated urinary tract infections
  • bladder adenocarcinoma
  • colonic adenocarcinoma
  • self-image
  • uterine prolapse

The A1 Medical Center Bladder Exstrophy Treatment

The bladder exstrophy treatment is unique because it focuses on repairing tissue damage and restoring function to improve each patient’s quality of life.

Patients are treated by minimally invasive endourethral by injecting the autologous stem cells or by injecting them directly into the dammaged area, avoiding major surgical intervention in most cases.

Diagnostics and Physical Assessment

Before stem cell implantation, each patient undergoes blood tests at the clinic and a comprehensive physical and cognitive assessment.

Step 1 – Bone Marrow Collection

Bone marrow is collected from the patient’s iliac crest (hip bone) using thin-needle mini-puncture under local anesthesia. Though some pain may be felt when the needle is inserted, most patients do not find the bone marrow collection procedure particularly painful. The entire procedure normally takes about 30 minutes.

Once the bone marrow collection is complete, patients may return to their hotel and go about normal activities.

More detailed information on the bone marrow collection procedure is available in the Bone Marrow Informed Consent document (PDF file).

Step 2 – Laboratory Processing

The stem cells are processed from the bone marrow in a state-of-the-art, government approved (cGMP) laboratory. In the lab, both the quantity and quality of the stem cells are measured. These cells have the potential to transform into multiple types of cells and are capable of regenerating or repairing damaged tissue.

Step 3 – Stem Cell Implantation

The stem cells are implanted back into the patient.

Following Treatment

Patients treated by endourethral transplantation may return home the day after treatment. Pelvic floor electrical stimulation and continued pelvic floor exercises could be recommended after treatment.

Results

40 patients underwent autologous transplantation. All patients had persistent urinary incontinence after bladder neck reconstruction and bulking agent injection. Patients were followed for 4 years after autologous  transplantation regarding clinical outcomes and cystometric, urodynamic, uroflowmetric and urethrocystoscopic evaluations. Health related quality of life was also measured before treatment and at final followup.

No evidence of urinary obstruction was observed.  71% of the patients were completely continent and  29% were socially dry with complete daytime dryness at final followup. Health related quality of life was improved significantly. Urodynamic studies revealed a progressive increase in bladder capacity (p <0.001). Mean detrusor leak point pressure showed a 27 cm H(2)O (158%) increase during 4-year followup. Uroflowmetry parameters of voided volume and average maximum flow rate were improved significantly (p <0.001).

The 4-year outcomes demonstrate that autologous myoblast transplantation for urinary incontinence in patients with bladder exstrophy-epispadias complex is relatively reliable, reproducible, safe and effective with minimal morbidity.

Patient Stories

Lavinia Conopan – 31 years old
“…I can now feel when I need to go to the toilet and my bladder capacity has increased…”

Ransom Doyle – 52 years old
“…I have been able to increase my distance walking to over 400+ meters with a cane and riding a two-wheel bicycle over a mile at a time…”

Rich Welsh – 27 years old
“…If you happen to have the chance of autologous stem cell treatment do not let it pass you by…”

Treatment Evaluation Process

In order to be evaluated for stem cell treatment, patients must complete an online medical history form. Once you’ve completed the online medical history and submitted it, a patient relations consultant will contact you. He or she will assist you with the rest of the evaluation process. Upon treatment approval, your consultant will also assist you with treatment scheduling and trip preparation.

 

Picture Source: BMJ Case Rep. 2011; 2011: bcr0420114141 and Wikipedia

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