Bladder exstrophy in the developing world.

Comments The KwaZulu-Natal region is home to multidrug resistant tuberculosis and high rates of HIV/AIDS. It remains one of the poorest regions in the world. In contrast to developed countries where the infant mortality rates associated with exstrophy approach that of the general population, children born with exstrophy in developing countries face a signifi cant risk of death associated with this condition. The specifi c reasons for this are largely infectious in nature. For those survivors, the morbidity of exstrophy is similar to that seen in the West, with urinary incontinence being a primary concern. Other investigators have noted an increased incidence of congenital anomalies, including exstrophy in countries affected by civil war [1]. In comparison to New York State, the incidence of exstrophy in the KwaZulu-Natal region is higher than expected, suggesting a possible association between poverty and exstrophy [2]. Whether the dissemination of more recent combination surgical techniques, such as the Mitchell (complete primary exstrophy repair) or Kelly (radical soft tissue exstrophy repair), will positively impact these outcomes in a resource-poor region remains to be seen.