Hauwa U., 18

Hauwa is an 18 year old female teenager who is staying with her parents in their mud apartment with no electricity, pit toilet, and well. She is in a government secondary school furthering her education but not sure what to become. The family is an extended family and poor. No work only seasonal farming. a pit toilet, a well, and no electricity. The family income is 3500. Hauwa was born with abnormal fleshy mass protruding through her lower abdomen and urine gushing out uncontrollably. The upper part of her genitals is open anteriorly. About 6 months ago she started having pain on the exposed mass with redness and bleed easily on contact. Examination revealed a young woman with ammoniacal smell, abdominal shows a defective suprapubic anterior abdominal wall with bladder extropy, urine jetting out of the ureters, exposed bladder mucosa is pliable with hyperemic area. There is bifid clitoris and pubic diathesis. Diagnosis of Ectropia Vesicae with metaplasia was made. The family are poor but they heard about Helpster Charity and contacted a volunteer for help. She was evaluated for multistage, multidisciplinary Surgery.

Hauwa Usman, an 18-year-old female, was admitted for management of congenital bladder exstrophy with metaplasia and underwent bladder and anterior abdominal wall reconstruction. Postoperatively, she developed partial wound dehiscence with serous fluid collection and subsequently a lower urethral/urethrocutaneous fistula with urine leakage. The wound was managed conservatively with regular dressing, drainage and positioning to reduce tension and fluid accumulation. Histology of the ulcerated bladder mucosal lesion was benign. She gradually improved, with good healing of the upper wound and reduced fistula drainage. The proposed fistula repair was discussed with her relatives, but her mother declined the procedure. She was discharged with continued wound care and follow-up.

Hauwa presented with continuous urinary leakage, mucosal inflammation, and associated genital anomalies and was diagnosed with Ectopia Vesicae. Management involves staged surgical reconstruction of the bladder and abdominal wall, with long-term surveillance for complications, including malignancy, urinary dysfunction, and recurrent infections. This condition is only amenable to surgery. It should have been done early before it ulcerate hence it makes it an urgent case to prevent risk of transformation to cancer (if that has not occurred already). Further delay also makes the remnant of the bladder to contract and thicken (fibrotic) due to repeated insult. Surgery aims to prevent those complications and try to restore continence of urine.