Long-term follow-up (18-35 years) of male patients with history of bladder exstrophy (BE) repair in childhood: erectile function and fertility potential outcome

Abstract

Introduction: Bladder exstrophy is a rare condition that may lead to severe psychosexual malformation and require a lifelong follow-up.

Aim: We describe the long-term sexual outcome of patients with bladder exstrophy treated at our institution at early stage.

Methods: Thirty patients with mean age of 26 years (range 18-35 years) were included in the study. Fifteen patients underwent staged primary reconstruction, five patients underwent complete primary repair, and 10 patients underwent primary or secondary ureterosigmoidostomy.

Main outcome measures: Evaluation consisted of pediatric medical records, interview questionnaire including the psychosexual history, International Index of Erectile Function (IIEF), and semen analysis.

Results: Erectile functions were maintained in 28 patients based on IIEF domain score. In all cases, penile length was objectively less than average (mean 7.65 cm). Seven patients were not satisfied with their penile length, and four cases complained of slight curvature. Ten patients were married (33%), of whom four patients had children (after normal conception in three, and after assisted reproductive technique in one). The remaining 20 patients were not married because of the feeling of sexual inadequacy to be able to engage in sexual intercourse (six patients), afraid of the cosmetic appearance of the genitalia (10 patients), and incontinence (four patients). Retrograde ejaculation was documented in 16 cases (53.5%), low volume ejaculate in eight cases (26.5%), and anejaculation in six cases (20%). Cosmetic outcome was considered satisfactory by 50% of the patients. Sixteen patients voided per urethra, four performed clean intermittent catheterization, and 10 patients had ureterosigmoidostomy diversion. Urinary tract infection was documented in 20% of the cases, and recurrent attacks of pyelonephritis in 10% of the cases.

Conclusion: Long-term outcome of bladder exstrophy repair in male patients showed fair results with respect to sexual function with more or less stable sexual relationship. We should do our best to solve the problem of those with restricted sexual lives.