Penile Length in Adults after Baldder Exstrophy Reconstruction

Abstract

PURPOSE In this group of patients penile length and deformity causes the greatest disability in long term follow-up. No operation has been designed yet to make the penis longer in adulthood. The aim of this study is to analyze the size of the penis and compare it with the normal population and whether the initial repair of the epispadias with different techniques influences these results. MATERIAL AND METHODS We retrospectively reviewed 68 bladder exstrophy males operated in our hospital. All patients were older than 18 yrs and were divided in 2 groups, those with initial diversion and those with staged closure. All of them had the same evaluation, interview, penile measurement length and girth at rest and erection, sexual relationship, stable partner and siblings. We used the Schneider´s normogram of normal population to compare the penile length results. RESULTS Only 35 patients (11 diversions, 24 staged closure) were localized, accepted interview or responded to the questionnaire. Our results in penile size compared with normal population are shown in the table. There were not significant differences in penile size in our both groups . Thirty three patients have normal ejaculations, 18p (51%) have sexual intercourse (satisfactory for both partners in 14) and 15 (43%) have a stable partner. Table 1 Normal population Bladder Exstrophy Age 18.4 yrs (18-19) 25 yrs (18-42) Flacid length 8.6 cm (5-14) 4.3 cm (2.5-6) Erect length 14.4 cm (10-19) 7.3 cm (4.5-11) Flacid width 3.08 cm (2.2-4.2) 3.3 cm (2.5-4.6) Erect width 3.4 cm (2.4-4.5) 3.45 cm (2.4-4.3) Dorsal or lateral chorde -------- 46% CONCLUSIONS Penile size in these patients is clearly less then the normal population in length but not in width. Nearly 50% of the reconstructed epispadias needed a redo to improve the erection. Sexual relationships and grade of satisfaction was higher than expected, obviously in those with at least 7 cm of penile length on erection.