To evaluate patients with classic bladder exstrophy (BE) and urinary diversion (UD) for sexual function, social integration and paternity.
The medical records of male exstrophy patients >18 years having undergone UD in our department between 1969 and 2014 were reviewed and patients were invited for structured follow-up examinations.
Patients were asked to complete questionnaires relating to sexual function, social integration and paternity.
39 of 79 eligible patients (49%) with a follow-up of 23. 8 years (2-45) were included in the study. 41% had undergone primary UD and 59% secondary UD after failed reconstruction of the exstrophic bladder. Sexual function as measured by the International Index of Erectile Function was negatively affected in all domains, with mild to moderate dysfunction in 90% of patients. 73% had a stable relationship and 32% were married. 77% achieved a high level of education. Sperm quality was poor (oligoasthenoteratozoospermia) in 71% patients. 11 patients fathered a total of 16 healthy children.
Despite multiple reconstructive procedures of the genitourinary tract including removal of the exstrophic bladder and subsequent UD, sexuality and paternity of a subset of patients is comparable with reported series of men in whom the bladder had been preserved. The evaluation of sexual function and fertility should be part of the long-term follow-up and treatment should be offered if indicated. Nowadays, staged concepts of exstrophy repair should be applied to improve the cosmetic and functional outcomes of the genitourinary tract in exstrophy patients.
The Journal of urology. 2015 Oct 13 [Epub ahead of print]
Peter Rubenwolf, Christian Thomas, Joachim W Thüroff, Raimund Stein
Department of Urology, Division of Pediatric Urology, Mainz University Medical Center, Mainz, Germany. Department of Urology, Mainz University Medical Center, Mainz, Germany. , Department of Urology, Mainz University Medical Center, Mainz, Germany. , Department of Urology, Division of Pediatric Urology, Mainz University Medical Center, Mainz, Germany.