The Outcome of Patients with Classic Bladder Exstrophy in Adult Life
To determine the outcome of twenty adult bladder exstrophy patients regarding urinary continence, sexual function, fertility and psychosocial integration.
Materials and Methods
Twenty patients (16 males, 4 females) filled an anonymous questionnaire and their charts were reviewed for medical history.
Nine patients are voiding spontaneously, with dry interval of 2 hours and more. Five patients are dry on clean intermittent catheterization. Three patients who had ureterosigmoidostomy are dry for more than 4 hours, and 3 had an incontinent stoma. Six patients are married (4 male, 2 female), of them 3 patients (2 males) had total of 7 children. Ten patients of 16 males (63%) reported to ejaculate a few cc in volume, 3 patients ejaculate only a few drops and 3 have no ejaculation (2 of whom underwent cystectomy). Semen analysis was done in 4 patients with the average volume of ejaculate being 0.4 cc (range 0.2–1 cc) 3 of whom had azoospermia and 1 oligospermia. All females reported regular and normal periods. Fifteen patients experienced normal erections which were described as satisfactory in 8 and not satisfactory in 6 because of a small penis and in 1 because of dorsal chordee. Twelve of the 16 males (75%) experienced satisfactory orgasms while 10 patients had participated in sexual intercourse with full partner satisfaction in nine. Half of the males and all females describe their intimate relationships as serious and long term. Fifteen of 20 patients (75%) achieve high level of education.
Bladder exstrophy patients generally achieve good results, however the fertility of most of the males is in doubt.
The staged reconstruction of bladder exstrophy generally achieves good results with urinary continence and cosmetically pleasing genitalia.1,2 However, by the time of puberty through adulthood, other factors gain more importance for patients with bladder exstrophy such as self esteem, sexuality, sexual function, fertility, and psychosocial integration. In females, reconstruction of the external genitalia is usually uncomplicated and the fertility is normal.3 Reconstruction of the male external genitalia and urethra is more complicated and in the past was more prone to complications. Since exstrophy patients have undergone multiple reconstructive surgeries of the urinary tract and many had recurrent urinary tract infections their fertility is at risk. Also, these patients have a relatively smaller penis. These factors may adversely affect the long term outcome of these patients. Since classic bladder exstrophy currently can be diagnosed prenatally, the outcome of patients with classic bladder exstrophy in the adult life is of great importance for prenatal counseling.4 The authors, report the outcome of 20 adult exstrophy patients who have been treated in our institution.
KeywordsSexual Function Urinary Diversion Ejaculatory Duct Clean Intermittent Catheterization Urinary Continence
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- 4.Gearhart J.P., Ben-Chaim J., Jeffs R.D. and Sanders R.: Criteria for prenatal diagnosis of bladder exstrophy. Obstet and Gynecol. 85(6) June 1995 (accepted for publication).Google Scholar