The Outcome of Patients with Classic Bladder Exstrophy in Adult Life

Abstract

Purpose We determined the outcome of 20 adult bladder exstrophy patients regarding urinary continence, sexual function, fertility and psychosocial integration. Materials and Methods A total of 16 men and 4 women completed an anonymous questionnaire and the charts were reviewed for medical history. Results Of 9 patients who void spontaneously 6 are dry for 4 hours and 3 for 2 hours. Among the remaining 11 patients 5 are dry on clean intermittent catheterization, 3 who had undergone ureterosigmoidostomy are dry for more than 4 hours and 3 had an incontinent stoma. Four men and 2 women are married, including 2 men and 1 woman who had a total of 7 children. Ten of 16 men (63 percent) reported that they ejaculate a few cubic centimeters in volume, 3 ejaculate only a few drops and 3 have no ejaculation (2 of whom underwent cystectomy). Semen was analyzed in 4 patients (3 with azoospermia and 1 with oligospermia) and average volume of ejaculate was 0.4 cc (range 0.2 to 1). All women reported regular and normal menstrual periods. A total of 15 patients experienced normal erections that were described as satisfactory by 8 and not satisfactory by 6 due to a small penis, with dorsal chordee in 1. Of the 16 men 12 (75 percent) experienced satisfactory orgasms while 10 had participated in sexual intercourse with complete partner satisfaction in 9. Half of the men and all women describe intimate relationships as serious and long term. Of the 20 patients 15 (75 percent) achieved a high level of education. Conclusions Bladder exstrophy patients generally achieve good results but the fertility of most men is in doubt.