CENTERS OF EXCELLENCE

RARE CASE

The story of AKS (name concealed) is a good example of the inequities in our health system. He was born with a serious malformation of his urinary bladder and genitals called bladder exstrophy-epispadias complex. For 32 years he leaked urine into his underclothes and lived as a social outcast. He could not be married because his genitals were so malformed that he dreaded exposing this fact to anyone, let alone a partner. He survived as a petty shop owner and with this meager income approached many medical centers for help. Unfortunately, there were no specialists available in his home state of Orrisa willing to take on such a serious malformation.  He finally approached a tertiary referral center in Mysore from where he was referred to the pediatric urology service at Narayana Hrudayalaya.

A team of surgeons led by Dr.Ashley J D’Cruz the pediatric urologist at NH, were able to achieve diversion of his ureters into a intestinal conduit for controlled collection of urine, closure of his abdominal wall using complex techniques and reconstruction of his genitals to make it possible for him to lead a normal married life. For the first time he is hopeful of marrying and raising a family.

Dr. Ashley has repaired a number of these cases presenting at birth in stages retaining the native bladder. These patients now lead fairly normal lives. It was not possible in this case as the bladder had undergone precancerous changes because of constant exposure. This is the first time in twenty years of pediatric practice that he has encountered a case presenting at this late stage making reconstruction all that more difficult.