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open access eISSN 2093-3673

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Review Article

Anat Cell Biol 2023; 56(4): 421-427

Published online December 31, 2023


Copyright © Korean Association of ANATOMISTS.

Analyzing the factors that contribute to the development of embryological classical type of bladder exstrophy

Ria Margiana1,2,3 , Widya Juwita1 , Khoirul Ima2,3 , Zakiyatul Faizah1,4 , Supardi Supardi1

1Andrology Program, Faculty of Medicine, Airlangga University, Surabaya, 2Master’s Program in Biomedical Sciences, Faculty of Medicine, University of Indonesia, Jakarta, 3Department of Anatomy, Faculty of Medicine, University of Indonesia, Jakarta, 4Biomedical Science Department, Faculty of Medicine, Airlangga University, Surabaya, Indonesia

Correspondence to:Ria Margiana
Department of Anatomy, Faculty of Medicine, University of Indonesia, Jakarta 10430, Indonesia
E-mail: ria.margiana11@gmail.com
Zakiyatul Faizah
Biomedical Science Department, Faculty of Medicine, Airlangga University, Surabaya 60132, Indonesia
E-mail: zakiyatul-f@fk.unair.ac.id

*These authors contributed equally to this work.

Received: February 28, 2023; Revised: June 12, 2023; Accepted: June 18, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Bladder exstrophy is a rare congenital condition of the pelvis, bladder, and lower abdomen that opens the bladder against the abdominal wall, produces aberrant growth, short penis, upward curvature during erection, wide penis, and undescended testes. Exstrophy affects 1/30,000 newborns. The bladder opens against the abdominal wall in bladder exstrophy, a rare genitourinary condition. This study is vital to provide appropriate therapy choices as a basis to improve patient outcomes. This study may explain bladder exstrophy and provide treatment. Epispadias, secretory placenta, cloacal exstrophy, and other embryonic abnormalities comprise the exstrophy-spades complex. The mesenchymal layer does not migrate from the ectoderm and endoderm layers in the first trimester, affecting the cloacal membrane. Embryological problems define the exstrophy-aspidistra complex, which resembles epimedium, classic bladder, cloacal exstrophy, and other diseases. Urogenital ventral body wall anomalies expose the bladder mucosa, causing bladder exstrophy. Genetic mutations in the Hedgehog cascade pathway, Wnt signal, FGF, BMP4, Alx4, Gli3, and ISL1 cause ventral body wall closure and urinary bladder failure. External factors such as high maternal age, smoking moms, and high maternal body mass index have also been associated to bladder exstrophy. Valproic acid increases bladder exstrophy risk; chemicals and pollutants during pregnancy may increase bladder exstrophy risk. Bladder exstrophy has no identified cause despite these risk factors. Exstrophy reconstruction seals the bladder, improves bowel function, reconstructs the vaginal region, and restores urination.

Keywords: Congenital abnormalities, Bladder exstrophy, Fetal anomalies, Urogenital system, Reproductive health

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