Long-term follow-up of male patients after reconstruction of the bladder–exstrophy–epispadias complex: Psychosocial status, continence, renal and genital function
Received 5 May 2009; accepted 5 June 2009. published online 13 July 2009.
Abstract
Objective
There is a paucity of knowledge about long-term outcome issues in the bladder–exstrophy–epispadias complex (BEEC). Adult male BEEC patients were investigated in respect of bladder and renal function, fertility, genital function and psychosocial facts.
Patients and methods
In a cross-sectional study, 17 adult male BEEC patients (mean age 23.4 years) from a single centre were evaluated with a questionnaire, renal and bladder ultrasound, blood tests, hormonal profile and semen analysis.
Results
Phenotypically one patient had complete epispadias and 16 had classical bladder exstrophy. Five patients underwent a one-stage functional reconstruction as a primary and 12 as a redo procedure. After a mean follow-up of 19.4 years, 15 bladders were preserved with 12 voiding per urethram and 3 performing intermittent catheterization; 2 were secondarily diverted. Significant residual urine was present in 10; kidneys were normal in 14 patients. Sixteen patients proved ejaculations, 3 had normospermia, 7 oligoasthenospermia and 6 azospermia. In patients with only one single bladder neck procedure normospermia was statistically significant.
Conclusion
After functional BEEC reconstruction, long-term bladder function is preserved with mostly normal renal function. The number of bladder neck attempts has a significant influence on andrologic outcome. Detailed analysis may detect multifactorial pathogenesis from the impaired sperm quality in the BEEC.
aDepartment of Paediatric Urology, University Medical Centre Regensburg, Steinmetzstr. 1-3, 93049 Regensburg, Germany
bDepartment of Urology and Paediatric Urology, University of Erlangen, Germany
cCentre for Gynaecological Endocrinology, Reproductive Medicine and Human Genetics, Regensburg, Germany
Correspondence to: Anne K. Ebert, Department of Paediatric Urology, University Medical Centre Regensburg, Steinmetzstr. 1-3, 93049 Regensburg, Germany. Tel.: +49 941 3695451; fax: +49 941 3695455.
ABSTRACT