Bladder exstrophy: Psychological impact during childhood

Purpose: We describe the impact of bladder exstrophy on the behavior, self- esteem and quality of life of children as well as on the parents, and analy ze the need for psychological intervention. Materials and Methods: All 7 boys and 8 girls 3 to 18 years old (median age 11) under treatment at a tertiary pediatric surgery clinic were included i n our followup study. Medical and psychological evaluations were performed. Behavior was assessed using the semistructured Hok-Cederblad Child Behavio r Interview and the Child Behavior Checklist questionnaire. Self-esteem was assessed by the self-rating I Think I Am questionnaire. Children and paren ts were interviewed separately. Quality of life was estimated using the Mul tiattribute Health Status Mark II classification system. Results: After repeat operations and hospitalization 10 children were dry, although 9 required catheterization. Four children had some behavioral prob lems, which were manifest in 2. All but 1 male adolescent had good or very good self-esteem. Quality of life was decreased in most cases due to limite d self-care, although emotional problems were few. All mothers had experien ced the birth as a traumatic event and 5 parents had had psychiatric sympto ms. Conclusions: Self-esteem may be maintained despite multiple operations, uri nary leakage and deviant genitalia but the abnormality had a great impact o n children and on the lives of the families. Parents and children required individual intervention from a multidisciplinary team during different stag es of childhood.