A rare congenital anomaly of urinary bladder was treated successfully in a newborn girl at AIIMS Nagpur.
The newborn girl was delivered at a private hospital in Nagpur. Parents were shocked to see a large part of the lower abdominal wall missing, which exposed the urinary bladder. In addition, the parents were also informed that even the front part of the bladder was not developed leading to a continuous leak of urine through the defect. The baby was then referred to AIIMS for further management.
This condition is called as exstrophy bladder. It is rare in girls and has the incidence of 1 in 50,000 live births. The management included preoperative preparation, complete urogenital reconstruction and intensive postoperative care.
A team of Neonatologists led by Dr. Nishant Banait along with pediatric surgeons and pediatric anesthetist took the daunting task of managing the patient. Baby was prepared for major surgical reconstructive procedure with a strong back up from a well-equipped NICU having trained staff. An expert team of Pediatric Anesthesiologists comprising of Dr. Bhuvaneswari B and Dr. Barkha Agarwal along with Dr. Omshubham Asai and senior resident, Dr. Vijay Kalaskar took the challenge of giving Anesthesia to very small baby weighing only 2.2 Kg.
A team of pediatric surgeons led by Dr Nilesh Nagdeve and Dr Rafey A. Rahman performed the complex reconstructive surgery which lasted for approximately 6 hours.
“The age and weight of the baby, difficult airway, requirement of long duration venous access, nature of major reconstructive procedure, blood loss associated with the surgery and difficult peri-operative management were the major challenges in front of the multidisciplinary team” said Dr Nishant Banait, Clinical-Incharge of the Department of Neonatology.
With the availability of the state of the art NICU having advanced equipment at the institute along with dedicated efforts of the entire team, all the challenges were addressed and baby was successfully managed and discharged home after 3 weeks of intricate NICU stay.
“Exstrophy bladder is a rare congenital anomaly of urinary bladder and treatment is perplexing due to the need for complex reconstructive procedure. Scientific literature suggests high failure rate of these reconstructive procedure, especially in newborn girls. Many of these patients are neglected and may see the doctor for the first time in school going age. They also face constant teasing by other children and adults due to the urinary leak. Most of these patients are psychologically distressed. Some may not get medical attention and withdraw themselves from the society” said Dr Nilesh Nagdeve, Head of Department of Pediatric Surgery. The parents belonged to low socio-economic strata but baby received complete treatment free of cost under MJPJY scheme. The constant support and guidance from the Hon’ble Director Maj Gen (Dr) Vibha Dutta, SM and Medical Superintendent Dr Manish Shrigiriwar encouraged the doctors to manage and successfully treat this exceedingly challenging condition.