Rehabilitation of Urinary Incontinence Following Delayed Bladder Exstrophy Repair in a Female Child

Bladder exstrophy is relatively rare and is even more rarely referred for rehabilitation. A nine-year-old girl with congenital bladder exstrophy from Samar presented with an abnormally low umbilicus, an abdominal opening below the umbilicus, and an anteriorly located anus. The patient has had no prior medical consult. She underwent primary repair of the exstrophy, anterior innominate bone osteotomy, application of external fixators, and traction. Postoperatively, the patient was referred for multidisciplinary rehabilitation management. The rehabilitation bladder program consisted of bladder training with clean intermittent catheterization, use of voiding diaries, fluid restriction, timed voiding, electrical stimulation, and pelvic floor muscle exercises. Bed sore care, pulmophysiotherapy, and strengthening exercises for lower extremities were also implemented. At present there are no validated guidelines in the management of urinary incontinence among female children with pelvic surgery, specifically for bladder exstrophy. This case report aims to present the rehabilitation management of a female pediatric patient with delayed bladder exstrophy repair, resulting in improved outcome.