Long Term Results of Bladder Exstrophy
After primary bladder closure or urinary diversion, other factors apart from the reconstruction gain importance for individuals with the exstrophy-epispadias complex: social integration and, after reaching puberty, sexuality and fertility.
Between 1968 and 1994 115 patients with bladder exstrophy or incontinent epispadias underwent surgery at our institution. A total of 104 patients could be followed, 2 of whom died in the meantime.
94% of the patients with rectal reservoirs and 97% of those with a Mainz pouch I are continent day and night, whereas only 3 of 6 patients with a sling plasty (incontinent epispadias) or with primary bladder closure followed by a Young Dees procedure are continent. The upper urinary tract remained stable at the latest followup in between 95% (Mainz pouch) and 98% of the renal units (rectal reservoirs).
Of the 104 patients 48 attend school, 4 are in college, 42 have completed or are currently undergoing vocational training, 3 are unemployed, 1 lives in a therapeutic center, 4 attend kindergarten and 2 are younger than 4 years of age.
In females reconstruction of the external genitalia resulted in normal sexuality and fertility. Reconstruction was performed in 25 and fixation of the uterus in 13 to correct or prevent uterine prolapse. Of the 17 women older than 18 years of age with genital recon-struction, 16 are satisfied with the cosmetic result. All adults engage in sexual intercourse. Five women have delivered 7 children by Caesarean section.
In male patients cosmetic results were satisfactory, however, at the expense of the fertility. Penile deviation was present in 11 of the 32 patients with genital reconstruction, which is distressing in only 2. Thirty patients are satisfied with the cosmetic result. 9 males developed epididymitis, necessitating 2 orchiectomies and 3 vasectomies. No patient with reconstruction of the external genitalia ejaculates normally or has fathered children, whereas ejaculation was normal in 3 men who did not undergo genital reconstruction. Of these, 2 men have fathered 4 children.
Conclusion: In individuals with the bladder exstrophy-epispadias complex Education, Occupation and social development is normal. The cosmetic results achieved by genital reconstruction are satisfactory. In female patients, antefixation of the uterus should be performed before or together with an introitusplasty to prevent uterine prolapse. In male patients, however, surgery is performed at the expense of fertility.
KeywordsCosmetic Result Urinary Diversion External Genitalia Uterine Prolapse Retrograde Ejaculation
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