Summary
Introduction
The penis in exstrophy–epispadias complex (EEC) males is diminutive and patients are
often dissatisfied with appearance and length. Due to an increased risk of psychosexual
dysfunction, patients desire penile reconstruction. Surgical options include penile
lengthening with a full thickness skin graft (SG) or tissue expansion (TE) used for
cutaneous coverage or neophalloplasty using a radial forearm free flap or pedicled
antero-lateral thigh flap.
Objective
The aim of this study was to assess sexual health outcomes before and after SG or
TE assisted lengthening and neophalloplasty.
Study design
Patients aged 18 years or older, who underwent penile reconstruction were identified
using an institutionally approved database of EEC patients. Patient perception of
penile appearance, sexual function, their frequency of sexual intercourse and overall
satisfaction with reconstruction were assessed using a survey consisting of validated
and non-validated questions.
Results
Eighty-three patients underwent penile reconstruction, 57 met the inclusion criteria
and 28 responded to the survey (49.1%). Fourteen were reconstructed using a SG, 6
with TE and 8 underwent neophalloplasty. Median time from reconstruction to survey
completion was 4.4 years (range 1.2–13.2) Four patients had a diagnosis of epispadias,
1 cloacal exstrophy, 23 classic bladder exstrophy (CBE). Before reconstruction patients
were dissatisfied with their penile appearance with a median penile perception score
of 4.5 compared to 7.5 after surgery (p = 0.0034, Fig. 1). Twenty-three patients were dissatisfied with penile length, with 18 reporting an
improvement following reconstruction (p = 0.0002). There was no correlation in time
after reconstruction with PPS or satisfaction with penile length (p = 0.86 and p = 0.55,
respectively). Overall, the median Sexual Health Inventory for Men (SHIM) score was
19, with no difference between the surgical groups (p = 0.33). Nine patients engaged
in sexual intercourse before reconstruction which increased to 17 afterwards.
Conclusion
All three surgical methods improved patient perception of penile appearance and length.
Patients who previously never engaged in intercourse were able to and those who had
were doing so more frequently, of which a greater proportion were in a relationship.
The results are encouraging though must be interpreted with caution due to the small
number of responders and possible risk of bias. These findings provide vital information
for future patients and routine psychological assessment will help manage patient
expectations to improve satisfaction.
Keywords
Abbreviations:
EEC (exstrophy–epispadias complex), TE (tissue expansion), SG (skin graft), RFFF (radial forearm free flap), PALTF (pedicled antero-lateral thigh flap), IPP (inflatable penile prosthesis), PPS (Penile Perception Score), SHIM (Sexual Health Inventory for Men), MSHQ-EjD-SF (Male Sexual Health Questionnaire short form for assessing ejaculatory dysfunction), CBE (classic bladder exstrophy), CE (cloacal exstrophy), MSRE (modern staged repair of bladder exstrophy), CPRE (complete primary repair of exstrophy), IQR (interquartile range), ED (erectile dysfunction)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 23, 2022
Accepted:
February 15,
2022
Received in revised form:
February 1,
2022
Received:
December 13,
2021
Identification
Copyright
© 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
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Access this article on ScienceDirectLinked Article
- Commentary to “Sexual health outcomes after penile reconstruction in the exstrophy epispadias complex”Journal of Pediatric UrologyVol. 18Issue 6
- PreviewIn this study, Harris et al. [1] assess the sexual health of 57 adult males with bladder exstrophy-epispadias complex (EEC) who had undergone penile reconstruction. 28/57 responded to the survey by validated and non-validated questions. They compared 3 surgical methods for penile lengthening using free skin grafts (SG), tissue expanders (TE) and neo phalloplasty, the overall the median SHIM score was 19 with no difference between the 3 groups.
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