A 27-YEAR-OLD PATIENT WITH CONGENITAL BLADDER EXSTROPHY AND RECURRENT PELVIC ORGAN PROLAPSE: A CASE REPORT/RECIDIVIRAJUCI PROLAPS ZDJELICNIH ORGANA KOD 27-GODISNJE BOLESNICE S PRIRODENOM EKSTROFIJOM MOKRACNOG MJEHURA: PRIKAZ SLUCAJA

• Published in: Acta clinica Croatica (Tisak) 2020-06, Vol.59 (2), p.373
• Main Authors: Banovic, Vladimir, Mikus, Mislav, Kalafatic, Drzislav, Mandic, Vjekoslav, Oreskovic, Slavko
• Format: Article
• Language: English
• Subjects: Care and treatment; Case studies; Congenital bladder anomalies; Diagnosis; Uterine prolapse
• ISSN: 0353-9466
• DOI: 10.20471/acc.2020.59.02.24

Bladder exstrophy (BE) is a rare congenital malformation estimated to occur in up to 1/250,000 female live births. The evidence supporting the incidence, uterine preservation and its overall fertility rate in patients with pelvic organ prolapse (POP) and BE is not precisely determined. We report a case of BE and POP in a 27-year-old nulliparous Caucasian. Due to the patient's strong fertility desire, considering her extensive surgical history background, our approach was to correct POP via the Manchester-Fothergill procedure. After 36 months, the patient was still asymptomatic with no evidence for prolapse recurrence. This case demonstrates diagnostic challenges and surgical dilemmas in treatment strategy for patients with BE and co-existent POP. Furthermore, routine long-term surveillance is necessary in terms of renal function, urinary continence, malignancy and possible obstetric issues. Key words: Bladder exstrophy; Pelvic organ prolapse; Pregnancy; Manchester-Fothergill procedure Ekstrofija mokracnog mjehura je rijetka prirodena malformacija za koju se procjenjuje da se javlja u do 1/250.000 ženske novorodencadi. Prema trenutnim literaturnim navodima imamo nedovoljno podataka o incidenciji i ukupnoj reproduktivnoj sposobnosti žena koje istodobno uz ekstrofiju mokracnog mjehura imaju i prolaps zdjelicnih organa. Prikaz slucaja obuhvaca naše iskustvo lijecenja 27-godišnje bolesnice s prirodenom ekstrofijom mokracnog mjehura i recidivirajucim prolapsom zdjelicnih organa. S obzirom na snažnu želju bolesnice za ocuvanjem plodnosti te uzimajuci u obzir njezinu opsežnu kiruršku povijest, naš pristup je podrazumijevao ispravak prolapsa zdjelicnih organa pomocu operacije po Manchester-Fothergillu. Nakon 36 mjeseci bolesnica je i dalje bez simptoma te bez ikakvih klinickih dokaza recidiva prolapsa. Ovaj slucaj naglašava dijagnosticke izazove i kirurške dileme u strategiji lijecenja bolesnica s ekstrofijom mokracnog mjehura i istodobnom pojavom prolapsa zdjelicnih organa. Takoder, važno je naglasiti dugotrajno rutinsko pracenje u vidu kasnije bubrežne funkcije, moguce inkontinencije mokrace, maligniteta i mogucih opstetrickih komplikacija. Kljucne rijeci: Ekstrofija mokracnog mjehura; Prolaps zdjelicnih organa; Trudnoca; Operacija po Manchester-Fothergillu