Bladder exstrophy arises from a failure of mesodermal migration with breakdown of ectoderm and endoderm resulting in absence of the anterior abdominal wall and anterior bladder wall. It is more common in males than females.
The umbilicus is abnormally low. The bladder mucosa is present as a contracted small circular plaque in the lower abdomen. The pubic bone is unfused and there may be apparent rotation of the lower limbs; this may be apparent radiologically.
In males, the penis is epispadic and up-turned; in females, the genital tract is usually normal although vaginal stenosis may require surgical intervention in early adult life.
As a tip for examinations, the pubic symphysis is often wide on the abdominal film.
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