Certain treatments for other cancer may raise
the risk for bladder cancer. These include radiation
therapy to the pelvic region, notably women who
received such treatment for ENDOMETRIAL CANCERor
CERVICAL CANCERor men for PROSTATE CANCER, and
chemotherapy with cyclophosphamide or ifos-
famide. People who have had such treatments
should receive ROUTINE MEDICAL EXAMINATIONwith
urinalysis and diagnostic procedures as doctor rec-
ommended for early detection of bladder cancer.
See also CANCER TREATMENT OPTIONS AND DECI-
SIONS; LYMPH NODE; METASTASIS; SKIN CANCER; STAGING
AND GRADING OF CANCER; SURGERY BENEFIT AND RISK
ASSESSMENT.
bladder catheterization The insertion of a nar-
row, flexible tube into the BLADDER through the
URETHRA to drain URINEfrom the body. Bladder
catheterization may be necessary to collect an
uncontaminated (sterile) urine sample or to drain
urine from the bladder. The catheter placement
may be short term, such as after surgery or during
serious illness, or long term, such as when STROKE,
PARALYSIS, or other condition results in loss of blad-
der control (complete URINARY INCONTINENCE).
Long-term catheterization may be intermittent,
in which the caregiver periodically inserts the
catheter to drain collected urine and then removes
the catheter, or indwelling (often called a Foley
catheter), in which the catheter remains tethered
in the bladder (a small inflatable balloon at the tip
of the catheter keeps the catheter from sliding out
of the urethra). An indwelling catheter drains into
a collection bag which the person or caregiver
empties frequently and regularly. A caregiver must
replace an indwelling catheter every four to six
weeks for hygienic reasons. Many people who
have indwelling catheters or who use long-term
intermittent catheterization take ANTIBIOTIC PROPHY-
LAXIS to prevent URINARY TRACT INFECTION (UTI).
Bladder catheterization greatly increases the risk
for UTI. Proper hygiene is essential when inserting
and removing a bladder catheter and when an
indwelling catheter is in place.
See also CYSTITIS;SPINAL CORD INJURY; TRAUMATIC
BRAIN INJURY(TBI).bladder exstrophy An uncommon CONGENITAL
ANOMALY in which the structures of the lower
pelvis fail to form properly. As a consequence, the
BLADDERprotrudes outside the body and may be
open or inverted. The URETHRAoften fails to close
as well. Bladder exstrophy is a random birth
defect and is not a hereditary birth defect. About
100 infants are born with bladder exstrophy,
which varies widely in severity, each year in the
United States.
Treatment in most cases is surgery within sev-
eral days of birth to reconstruct and reposition the
bladder, urethra, symphysis pubis, and other
pelvic structures. Most children born with bladder
exstrophy require follow-up operations through
early childhood and perhaps at PUBERTYwhen sec-
ondary sex characteristics alter the appearance
and function of the GENITALIA. However, even with
surgical repair or reconstruction the urethral
sphincter muscle at the neck of the bladder may
not function properly, resulting in incomplete
control over the flow of URINE. This URINARY INCON-
TINENCEmay remain throughout life, though there
are medical therapies and lifestyle methods to
manage the condition. VESICOURETERAL REFLUX, in
which urine flows (refluxes) from the bladder
back up the ureters, is also common.
Appropriate reconstructive surgery maintains
FERTILITY. Men may experience RETROGRADE EJACU-
LATION, in which SPERMtravel inward through the
urethra and into the bladder during ejaculation
rather than outward through the urethra to exit
the PENIS. In such a circumstance a fertility expert
can retrieve the sperm and place them into the
woman to achieve fertilization. Women born with
bladder exstrophy generally are able to carry PREG-
NANCYto term and deliver vaginally as long as the
circumstances of the pregnancy permit.
See also BIRTH DEFECTS; EPISPADIAS.bladder stone See UROLITHIASIS.182 The Urinary System