Prenatal diagnosis of bladder exstrophy: What counseling?

Purpose: Bladder exstrophy has recently become one of the several congenita l malformations detectable prenatally by fetal ultrasonography, which impli es the necessity of a correct prognostic evaluation of quality of life on w hich therapeutic termination of pregnancy may depend within the temporal li mits stated by the law. While maintaining a preeminently informative role, prenatal counseling has gained increasing relevance for the quality of life long-term prognosis in adults affected by bladder exstrophy, particularly in regard to urinary continence, and sexual and reproductive problems in ma le and female individuals. We report a case of bladder exstrophy diagnosed at 22 week of gestation, and comprehensively review the literature on prena tal diagnostic tools and procedures as well as long-term followup in such c ases. Materials and Methods: At week 22 of gestation a woman underwent prognostic counseling due to the diagnosis of fetal bladder exstrophy made by prenata l ultrasound. After counseling the parents elected pregnancy termination. I n addition, literature data were analyzed in regard to quality of life and bladder exstrophy. Results: We believe that the rarity of the prenatal diagnosis of this abnor mality has resulted in the lack of a comprehensive review of necessary coun seling criteria. Conclusions: We suggest what we consider to be a valid counseling approach for parents after a prenatal diagnosis of bladder exstrophy.