Which condition is most associated with bladder exstrophy?

Bladder exstrophy is a congenital anomaly characterized by the abnormal development of the bladder, where the bladder is exposed on the outside of the body. This condition is frequently associated with epispadias, a malformation in which the urethra opens on the upper side of the penis in males or in the vicinity of the clitoris in females. The reason for this association stems from the embryonic development of the urogenital system, where both bladder exstrophy and epispadias arise from disruptions in the mesodermal fusion processes.

In patients with bladder exstrophy, there is a higher likelihood of having epispadias due to the underlying developmental anomalies of the pelvic structures and the associated urinary tract. This connection is established in medical literature, which indicates that children with bladder exstrophy often present with epispadias. In contrast, conditions like hypospadias, testicular torsion, and ureteral reflux do not have the same direct relation with bladder exstrophy and are more commonly seen in different contexts or with different pathophysiological mechanisms. Thus, the strong association between bladder exstrophy and epispadias makes it the most relevant choice in this scenario.