Plastic surgery; its principles and practice . th Ed. ScHOEMAKER. Ccntralbl. f. Chir., Nr. 39, 1914, , H. M. Jour. Amer. Med. Assn., Dec. 8, 1917, , W. T. Jour. ISIissouri State Med. Assn., 1917, xiv, 415. Thompson, J. E. Surg., Gyne. & Obst., May, 1912, , R. C. Surg., Gyne. & Obst., Oct., 1913, , P. R. Johnsons Operative Therapeusis, 1915, i, 457. Ulrich, I. Zent. f. Chir., Oct. 18, 1913, 1634. Vander Veer, A. Handbook of Med. Science, iv, 1914, 902. CHAPTER XIIEXSTROPHY OF THE BLADDER (ECTOPIA VESICAE) This distressing condition is caused by the mald
Plastic surgery; its principles and practice . th Ed. ScHOEMAKER. Ccntralbl. f. Chir., Nr. 39, 1914, , H. M. Jour. Amer. Med. Assn., Dec. 8, 1917, , W. T. Jour. ISIissouri State Med. Assn., 1917, xiv, 415. Thompson, J. E. Surg., Gyne. & Obst., May, 1912, , R. C. Surg., Gyne. & Obst., Oct., 1913, , P. R. Johnsons Operative Therapeusis, 1915, i, 457. Ulrich, I. Zent. f. Chir., Oct. 18, 1913, 1634. Vander Veer, A. Handbook of Med. Science, iv, 1914, 902. CHAPTER XIIEXSTROPHY OF THE BLADDER (ECTOPIA VESICAE) This distressing condition is caused by the maldevelopment ofthe structures which make up the anterior wall of the bladder, and thecorresponding portion of the abdominal wall. The posterior wallof the bladder protrudes much like a rosette, and on the lower portionof this mucous surface the urine is constantly being discharged from theexposed ureteral orifices. Associated with this condition ununitedpubic bones and epispadias are found. Occasionally double inguinalhernia is Fig. 264.—Complete exstrophy of the bladder with epispadias.—This patient wassubsequently cured by transplanting the ureters with a rosette of mucous membrane intothe rectum. Exstrophy of the bladder is rare, occurring only once in from30,000 to 50,000 births. It occurs much more frequently in males. Berger says that of 74 patients not operated upon, born withexstrophy of the bladder, only 2}, passed their 20th year, 68 per centdying of pyelonephritis. Time of Operation.—Children should be at least four or fiveyears of age. Good physical condition is essential for such a seriousoperation. Three general groups of operative procedures have been devisedfor the correction of this deformity. 298 EXSTROPHY OF THE BLADDER 299 (A) Those Whose Object is the Plastic Reconstruction of aBladder.—(i) By the formation of the anterior wall from pedunculatedflaps of adjacent skin. (Roux, 1852, Nelaton, Thiersch, Wood, andothers.) Woods method of forming
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