Medication Summary
Antibiotics are given to prevent urinary tract infections in patients with exstrophy and epispadias.
Broad-spectrum antibiotics
Class Summary
These agents are used for prevention of perioperative tissue infection due to preoperative colonization of urinary tract or multiple indwelling catheters.
Ampicillin (Marcillin, Omnipen, Polycillin)
Bactericidal activity against susceptible organisms. Started at birth in classic bladder exstrophy or cloacal exstrophy and continued through early postoperative period.
Gentamicin (Garamycin)
Aminoglycoside antibiotic for gram-negative coverage. Started at birth in classic bladder exstrophy or cloacal exstrophy and continued through early postoperative period.
Prophylactic antibiotics
Class Summary
These agents are used for prevention of urinary tract infection in light of vesicoureteral reflux and possible inefficient bladder emptying.
Amoxicillin (Trimox, Amoxil, Biomox)
First-line choice for prophylaxis in newborns. Interferes with synthesis of cell wall mucopeptides during active multiplication, resulting in bactericidal activity against susceptible bacteria. Used as prophylaxis in certain PO, GI, or genitourinary procedures.
Trimethoprim-sulfamethoxazole (Bactrim, Septra, Cotrim)
Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid. Switch from amoxicillin to TMP-SMZ after 2 mo; can dispense larger supply, making refills more convenient; susp contains 20 mg TMP and 100 mg SMZ per 5 mL; prophylactic dose is one half therapeutic dose.
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Open bladder plate and urethra with bifid clitoris in female patient with classic bladder exstrophy. Note low-set umbilicus and anteriorly displaced anus. Courtesy of Richard Rink, MD.
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Male with classic bladder exstrophy. Note low-set umbilicus and short, broad, upturned phallus. Distance between phallus and scrotum is abnormal. Courtesy of Richard Rink, MD.
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External view in female patient with epispadias. Labia are separated anteriorly. Courtesy of Richard Rink, MD.
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Female patient with epispadias with labia retracted. The clitoris is bifid, and the urethra is open dorsally. Courtesy of Richard Rink, MD.
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Penopubic epispadias in male patient. Typical spadelike configuration of glans penis with incomplete foreskin, dorsal urethral plate, and open bladder neck. Courtesy of Richard Rink, MD.
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46,XY newborn with cloacal exstrophy. A very large omphalocele is present, and the hemibladders flank the exstrophic cecal plate. The phallus is small and bifid, with the hemiglans and hemiscrotum located just distal to the bladder. Courtesy of Martin Kaefer, MD.
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Lipomeningocele in the same newborn shown in Image 6, a 46,XY newborn with cloacal exstrophy. Courtesy of Martin Kaefer, MD.
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Superior vesical fissure variant of exstrophy. Genitalia are normal. Patent urachus is considered in the differential diagnosis, although the opening is well below the umbilicus. Rectus abdominis and pubic abnormalities are found in the exstrophic variant but not with patent urachus. Courtesy of Richard Rink, MD.
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Female with covered exstrophy. The umbilicus is very low, the pubic bones are widely separated, and the rectus muscles are divergent. The bladder is intact, but the patient has undergone bladder neck reconstruction to achieve urinary continence. The external genitalia are normal. Courtesy of Elizabeth Yerkes, MD.
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Typical appearance of pelvis in patient with exstrophy-epispadias complex with wide separation of pubic symphysis.
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Bilateral vesicoureteral reflux and small-capacity bladder after initial exstrophy closure. Contrast escapes readily through the incompetent bladder neck.
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Use of plastic wrap to protect the delicate bladder mucosa in a newborn with bladder exstrophy. Courtesy of Richard Rink, MD.
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Subtotal prolapse of bladder wall through patulous bladder neck after bladder closure in female with cloacal exstrophy. The bladder mucosa appears healthy, and urine is draining freely. Courtesy of Richard Rink, MD.
