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Paraboschi I, Sampogna G, Di Grazia M, Rigamonti W, Berrettini A. Long-term psychosexual adjustment of adults born with classic bladder exstrophy. J Pediatr Urol 2024:S1477-5131(24)00203-1. [PMID: 38710600 DOI: 10.1016/j.jpurol.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 04/10/2024] [Accepted: 04/15/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND In literature studies exploring long-term psychosexual development and intimacy of adults living with the complex genitourinary conditions associated with classic bladder exstrophy (BE) are scarce, with small sample sizes and lacking in methodology. OBJECTIVE This study aims to examine areas of potential psychosexual distress in adults born with classic BE to develop targeted clinical interventions. STUDY DESIGN The validated Sexrelation Evaluation Schedule Assessment Monitoring (SESAMO) questionnaire was administered to all BE patients aged ≥18 years operated on in our tertiary referral center during infancy. Z-scores were calculated for each area of interest, considering i) gender (female vs male); ii) committed partnership status (singles vs couples); iii) the voiding technique adopted to empty the bladder. RESULTS A total of 33 (F:M 12:21; singles: couples 11:22) adults with BE were enrolled in the study at a median age of 39 (32-47) years. Overall, BE adults performed the worst regarding psychosexual identity (z-score:-1.282), pleasure (z-score:-0.915) and desire (z-score:-0.583); singles regarding relational attitude (z-score:-1.751) and imaginative eroticism (z-score:-0.806); couples regarding extramarital sexuality (z-score:-1.175) and sexual communication (z-score:-0.255). When it came to gender, females significantly performed worse than males regarding psychosexual identity (-1.645 vs -1.282; p-value:<0.0001) and areas of pleasure (-1.126 vs -0.359; p-value:<0.001). Single females performed worse than males regarding actual masturbation (-0.763 vs 0.583; p-value:<0.05) and better regarding relational attitude (-1.226 vs -1.751; p-value:<0.05). Females in stable relationships performed worse than males regarding actual masturbation (-1.645 vs 0.306; p-value:<0.05) and better regarding sexual intercourse (1.866 vs -0.565; p-value:<0.01). The voiding techniques used to empty the bladder did not show any influence on these results. CONCLUSION Adults with BE have a greater likelihood of experiencing a wide range of psychosexual difficulties. Identifying the specific areas of psychological distress can help them cope with their medical experience and actual clinical condition and clinicians plan adequate psychological interventions.
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Affiliation(s)
- Irene Paraboschi
- Department of Pediatric Urology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | | | | | - Waifro Rigamonti
- Urology Clinic-Pediatric Urology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy
| | - Alfredo Berrettini
- Department of Pediatric Urology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
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Hirsch AM, Morrill CC, Haffar A, Harris TGW, Crigger C, Jelin AC, Gearhart JP. Optimizing prenatal diagnosis and referral of classic bladder exstrophy: Lessons from a single-institution experience. J Pediatr Urol 2024:S1477-5131(24)00094-9. [PMID: 38433079 DOI: 10.1016/j.jpurol.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/15/2024] [Accepted: 02/17/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Classic bladder exstrophy (CBE) is a malformation of the genitourinary system that occurs due to failure of abdominal wall closure. Unlike other malformations of similar incidence, prenatal diagnosis of CBE relies on suggested, rather than formal, diagnostic criteria. OBJECTIVE This report describes prenatal diagnosis of CBE in the largest single-institutional cohort to date and delineates key sonographic findings and protocols for specialist referral. MATERIALS AND METHODS A single-institutional database was reviewed for CBE patients born since 2000. Data on screening ultrasound use, gestational age at ultrasound, and abnormal findings were extracted. Where possible, time of prenatal diagnosis (pre- or postnatal and gestational age), ultrasound findings and other imaging data, specialist referral, institution of birth and closure, and outcome of primary closure attempt were compared. RESULTS Of 557 patients born with CBE between 2000 and 2022, 284 met inclusion criteria and complete data were available for 280 (229 born domestically and 51 born internationally) who were included for analysis. Abnormal sonography suggestive of CBE was present for 48% (n = 134) of patients, for whom absent bladder was the most common abnormal finding (76% [102/134]). Of domestic patients, 46% (n = 106) were diagnosed prenatally at a median gestational age of 22 weeks (inter-quartile range [IQR]: 20-24), and 14% (n = 32) underwent confirmatory fetal magnetic resonance imaging. Of domestic patients with abnormal prenatal findings, 75% (n = 80/106) consulted with maternal-fetal medicine and 58% (n = 62/106) consulted with pediatric urology. On univariate analysis, prenatal diagnosis was positively associated with primary repair at Association for the Bladder Exstrophy Community-recognized centers of excellence (54% vs. 38%, p = 0.02) and negatively associated with osteotomy at primary closure (41% vs 59%, p = 0.003) but not success of primary closure (74% vs. 82%, p = 0.07). DISCUSSION Rates of prenatal diagnosis in this cohort were similar to previous reports of smaller cohorts. Diagnosis allows for comprehensive pre- and postnatal follow-up with a pediatric urologist, with implications on birth planning and decisions on termination of pregnancy. Because of the previously-reported association between exstrophy and in vitro fertilization, these pregnancies should undergo detailed sonography. Any nonvisualization of the fetal bladder should prompt a detailed exam, and any finding characteristic of bladder exstrophy warrants referral to pediatric urology. CONCLUSIONS Although CBE is a rare disorder, it is underdiagnosed during pregnancy. Sonographers and obstetricians should be aware of characteristic findings and best practices following diagnosis. Early referral to pediatric urology and maternal-fetal medicine is important for counseling and postnatal planning.
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Affiliation(s)
- Alexander M Hirsch
- Robert D. Jeffs Division of Pediatric Urology, Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | - Christian C Morrill
- Robert D. Jeffs Division of Pediatric Urology, Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | - Ahmad Haffar
- Robert D. Jeffs Division of Pediatric Urology, Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | - Thomas G W Harris
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Chad Crigger
- Robert D. Jeffs Division of Pediatric Urology, Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | - Angie C Jelin
- Director of First Trimester Screening Program, Department of Gynecology and Obstetrics, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | - John P Gearhart
- Robert D. Jeffs Division of Pediatric Urology, Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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Van den Eede E, Sterckx M, Vangelabbeek K, Dunford C, Noah A, Wood D, De Win G. An observational study on the sexual, genital and fertility outcomes in bladder exstrophy and epispadias patients. J Pediatr Urol 2023; 19:36.e1-36.e7. [PMID: 37856541 DOI: 10.1016/j.jpurol.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 10/06/2022] [Accepted: 10/08/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Bladder exstrophy and epispadias complex (BEEC) is a spectrum of congenital malformations ranging from an isolated epispadias to a full exstrophy. It is an uncommon disease and little is known on how patients cope with its implications later in life. OBJECTIVE The goal of this study is to assess the sexual, continence and fertility outcomes of BEEC patients, who had reconstructive bladder surgery during childhood. Considering the sensitive nature of these topics, they are not easily spoken about in the doctor's office. Our aim is to shed some light on possible points of improvement in follow-up. STUDY DESIGN 63 patients between 18 and 45 years old were sent an electronic questionnaire based on previous existing standardized questionnaires. They were asked about sexual and psychosexual wellbeing, urinary incontinence and fertility. Data from their medical files (medical history on previous surgeries). and questionnaire answers are linked through an anonymous subject number and put into an Excel file for descriptive representation. RESULTS 22 men and 8 women filled in the questionnaire. All but 2 are sexually active. Reasons to avoid sexual activity are equally divided as BEEC-related and non-BEEC-related. Sexual satisfaction is lower in the male group due to problems with erection, ejaculation, condom usage and embarrassment about physical appearance. In females problems concerning pain and reaching orgasm are mentioned. 30% report depressive feelings. There is a clear correlation between number of reconstructive surgeries and sexual satisfaction. 90% of patients urinate via catheterization, mostly through a Mitrofanoff connection. This leads to complications such as foul odors, infection, embarrassment and sexual dysfunction. 8 out of 13 men conceived a child (with the use of their own sperm), 2 out of 4 women did. DISCUSSION A strength of this study is the use of standardized questionnaires which allow comparison to a control patient group. Our study is one of the first to show how patients cope with the challenges of BEEC by the use of open questions. We see an overall high quality of life yet an important impact on mental health. CONCLUSION BEEC is associated with many challenges in the adult life of patients. A more holistic and interdisciplinary approach is needed to include sensitive topics in long term follow-up.
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Affiliation(s)
- Emma Van den Eede
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, Antwerp, 2610, Belgium
| | - Mira Sterckx
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, Antwerp, 2610, Belgium
| | - Kato Vangelabbeek
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, Antwerp, 2610, Belgium
| | - Charlotte Dunford
- Department of Urology, University College London Hospitals, 16-18 Westmoreland Street, London, United Kingdom
| | - Anthony Noah
- Department of Urology, University College London Hospitals, 16-18 Westmoreland Street, London, United Kingdom
| | - Dan Wood
- Department of Urology, University College London Hospitals, 16-18 Westmoreland Street, London, United Kingdom; Department of Urology at Children's Hospital Colorado - University of Colorado 13123 E 16th Ave, Aurora, CO 80045, USA
| | - Gunter De Win
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, Antwerp, 2610, Belgium; Department of Urology, University College London Hospitals, 16-18 Westmoreland Street, London, United Kingdom; Department of Urology, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium.
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Abstract
Male factor infertility is a common problem. Evidence is emerging regarding the spectrum of systemic disease and illness harbored by infertile men who otherwise appear healthy. In this review, we present evidence that infertile men have poor overall health and increased morbidity and mortality, increased rates of both genitourinary and non-genitourinary malignancy, and greater risks of systemic disease. The review also highlights numerous genetic conditions associated with male infertility as well as emerging translational evidence of genitourinary birth defects and their impact on male infertility. Finally, parallels to the overall health of infertile women are presented. This review highlights the importance of a comprehensive health evaluation of men who present for an infertility assessment.
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Affiliation(s)
- Nahid Punjani
- James Buchanan Brady Foundation Institute of Urology, Weill Cornell Medical College, New York, NY 10065, USA;
| | - Dolores J Lamb
- James Buchanan Brady Foundation Institute of Urology, Weill Cornell Medical College, New York, NY 10065, USA; .,Englander Institute for Precision Medicine, Weill Cornell Medical College, New York, NY 10021, USA.,Center for Reproductive Genomics, Weill Cornell Medical College, New York, NY 10065, USA
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5
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Long-term sexual outcomes in patients with exstrophy-epispadias complex. Int J Impot Res 2020; 33:164-169. [PMID: 32161399 DOI: 10.1038/s41443-020-0248-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/01/2020] [Accepted: 02/26/2020] [Indexed: 02/07/2023]
Abstract
Exstrophy-epispadias complex (EEC) is a spectrum of genitourinary malformations that ranges in severity and affects external genitalia and the lower urinary tract. The aim of this study was to determine the long-term sexual outcomes of patients with EEC. Sexual outcomes were hypothesized to be related to those of urinary ones. A retrospective database including all patients with EEC who had surgery at a tertiary referral institution from 1990 to 2019 was created. Data based on patient's charts were collected: demographics, surgeries, sexual outcomes, urinary outcomes. Fifty-eight patients with EEC had surgery at tertiary referral institution and entered our database. For this analysis of sexual outcomes, a sub-set of the whole population was selected: patients being 14 years old and older, having at least one surgery at our institution and having at least 12 months of follow-up. Applying this selection criteria to our database resulted in a series of 29 patients. High rates of sexual activity were observed in pubertal and post-pubertal men (96%) and women (75%). Seventy-nine percent of men and 67% of women reported sexual satisfaction; 63% of men reported normal ejaculation. To achieve these rates, 96% of men required surgery (84% penoplasty, 52% phalloplasty), and 25% of women required introitoplasty. Fertility was achieved in 67% of men and 100% of women. Assisted reproductive technology was needed in one man. Continence rates were high (diurnal continence in 83% and nocturnal continence in 93%). However, 76% required multiple continence procedures. Men and women with EEC can have good long-term sexual and urinary outcomes, but this may require multiple surgeries. Good sexual outcomes seem to be related to good urinary and continence outcome.
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Mallmann MR, Mack-Detlefsen B, Reutter H, Pohle R, Gottschalk I, Geipel A, Berg C, Boemers TM, Gembruch U. Isolated bladder exstrophy in prenatal diagnosis. Arch Gynecol Obstet 2019; 300:355-363. [PMID: 31115647 DOI: 10.1007/s00404-019-05193-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 05/10/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Isolated classic bladder exstrophy (CBE) is the most common variant of the bladder-exstrophy-epispadias complex (BEEC). The BEEC represents a spectrum ranging from isolated epispadias over CBE to the most severe form, cloacal exstrophy. We report on a series of 12 cases with CBE diagnosed prenatally and illustrate the spectrum of prenatal ultrasound findings with comparison to prior published reports on this entity. METHODS This was a retrospective study involving 12 fetuses with CBE at two large tertiary referral centers in Germany over a 14-year period (2004-2018). RESULTS Median diagnosis was made with ultrasound in 24 + 5 (IQR25,75: 21 + 2, 29 + 0) weeks of gestation. All fetuses presented with the pathognomonic findings non-visualization of the fetal bladder and protruding abdominal mass below the umbilical cord insertion. All fetuses showed normal kidney anatomy and normal amniotic fluid throughout pregnancy. Epispadia was visible prenatally on ultrasound in 6/8 male fetuses. 1/12 Parents opted for termination of pregnancy, 11/12 fetuses were live born and received reconstructive surgery. CONCLUSIONS Isolated CBE is an extremely rare prenatal sonographic finding. Prenatal diagnostics should exclude additional malformations within the spectrum of cloacal malformations.
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Affiliation(s)
- Michael R Mallmann
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany.
- Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany.
| | - Birte Mack-Detlefsen
- Department of Pediatric Surgery and Pediatric Urology, Children'S Hospital of Cologne, Cologne, Germany
| | - Heiko Reutter
- Department of Neonatology and Pediatric Intensive Care, University of Bonn, Bonn, Germany
- Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - Rebecca Pohle
- Department of Pediatric Surgery and Pediatric Urology, Children'S Hospital of Cologne, Cologne, Germany
| | - Ingo Gottschalk
- Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - Christoph Berg
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
- Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany
| | - Thomas M Boemers
- Department of Pediatric Surgery and Pediatric Urology, Children'S Hospital of Cologne, Cologne, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
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7
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Abstract
PURPOSE OF REVIEW Classic bladder exstrophy (BE) remains one of the most demanding reconstructive challenges encountered in urology. In female BE patients, the long-term sequela of both primary and revision genitoplasty, as well as intrinsic pelvic floor deficits, predispose adult women to significant issues with sexual function, pelvic organ prolapse (POP), and complexities with reproductive health. RECENT FINDINGS Contemporary data suggest 30-50% of women with BE develop prolapse at a mean age of 16 years. Most women will require revision genitoplasty for successful sexual function, although in some series over 40% report dyspareunia. Current management for pregnancy includes elective cesarean section with involvement of high-risk obstetrics and urologic surgery. This review encapsulates contemporary concepts of etiology, prevalence, and management of POP and pregnancy in the adult female BE patient.
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Affiliation(s)
- Melissa R Kaufman
- Department of Urologic Surgery, Vanderbilt University Medical Center, A-1302 Medical Center North, Nashville, TN, 37232-2765, USA.
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8
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Baumgartner TS, Lue KM, Sirisreetreerux P, Metzger S, Everett RG, Reddy SS, Young E, Anele UA, Alexander CE, Gandhi NM, Di Carlo HN, Gearhart JP. Long-term sexual health outcomes in men with classic bladder exstrophy. BJU Int 2017; 120:422-427. [DOI: 10.1111/bju.13866] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Timothy S. Baumgartner
- Division of Pediatric Urology; James Buchanan Brady Urological Institute; Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Kathy M. Lue
- Division of Pediatric Urology; James Buchanan Brady Urological Institute; Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Pokket Sirisreetreerux
- Division of Pediatric Urology; James Buchanan Brady Urological Institute; Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Sarita Metzger
- Division of Pediatric Urology; James Buchanan Brady Urological Institute; Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Ross G. Everett
- Division of Pediatric Urology; James Buchanan Brady Urological Institute; Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Sunil S. Reddy
- Division of Pediatric Urology; James Buchanan Brady Urological Institute; Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Ezekiel Young
- Division of Pediatric Urology; James Buchanan Brady Urological Institute; Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Uzoma A. Anele
- Division of Pediatric Urology; James Buchanan Brady Urological Institute; Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Cameron E. Alexander
- Division of Pediatric Urology; James Buchanan Brady Urological Institute; Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Nilay M. Gandhi
- Division of Pediatric Urology; James Buchanan Brady Urological Institute; Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Heather N. Di Carlo
- Division of Pediatric Urology; James Buchanan Brady Urological Institute; Johns Hopkins University School of Medicine; Baltimore MD USA
| | - John P. Gearhart
- Division of Pediatric Urology; James Buchanan Brady Urological Institute; Johns Hopkins University School of Medicine; Baltimore MD USA
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9
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Park W, Zwink N, Rösch WH, Schmiedeke E, Stein R, Schmidt D, Noeker M, Jenetzky E, Reutter H, Ebert AK. Sexual function in adult patients with classic bladder exstrophy: A multicenter study. J Pediatr Urol 2015; 11:125.e1-6. [PMID: 25986209 DOI: 10.1016/j.jpurol.2015.02.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 02/11/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The bladder exstrophy-epispadias complex (BEEC) comprises a spectrum of congenital anomalies that represents the severe end of urorectal malformations, and has a profound impact on continence as well as sexual and renal functions. OBJECTIVE The relation between severity of BEEC and its associated functional impairments, on one hand, and the resulting restrictions in quality of life and potential psychopathology determine the patients' outcome. It is important for improving further outcome to identify BEEC-related sources of distress in the long term. Genital function and sexuality becomes an important issue for adolescent and adult BEEC individuals. Hence, the present study focused on sexual function and psychological adaption in patients with BEEC. STUDY DESIGN In a multicenter study 52 patients (13 females, 39 males) with classic bladder exstrophy (BE) with their bladders in use were assessed by a self-developed questionnaire about sexual function, and psychosexual and psychosocial outcome. The patients were born between 1948 and 1994 (median age 31 years). RESULTS Twelve of 13 (92%) females and 25 of 39 (64%) males with classic BE had answered the questions on sexual function. Of these, 50% females and 92% males answered that they masturbated. Females had sexual intercourse more frequently. Six (50%) females affirmed dyspareunia whereas only two (8%) males reported pain during erection. Eight (67%) females specified having orgasms. Eighteen (72%) males were able to ejaculate. Two males and none of the females lived in a committed partnership (Figure). Two (15%) females and 13 (33%) males answered all psychosocial questions. The majority of these patients had concerns about satisfactory sexuality and lasting, happy partnerships. A minority of patients of both sexes were willing to answer psychosocial questions. Sexual activity and relationships of many adult BE patients seems to be impaired. Not surprisingly, sexual activity and awareness were different in males and females even in a multi-organ anomaly. DISCUSSION To date, one of the main goals of the medical treatment of BEEC/BE patients is to enable normal sexual life and fertility. However, only a few outcome studies have focused on these issues with contradicting results, most of them not using standardized outcome measures. In accordance with other studies, our female BE patients have dyspareunia and most of our male BE patients were able to ejaculate. But the question of normal force of ejaculation, ejaculated volume, or semen analysis remains unanswered. Despite partial confirmation of previous findings, there is inconsistency referring to the outcome measured by the available studies. This might in part be explained by the fact that, other than this study, most previous studies are the result of single-institution experience. Thus, selection bias in the patient sampling due to different a clinical collective in different hospitals may be the consequence. Furthermore, patients' honesty and self-reflection in answering difficult questions regarding their sexual and cosmetic impairments is questionable. In addition, studies include a wide range of age groups and are connected with this life period. Fears and condition-specific anxieties might change over time. Hence, the strengths of this study are the nationwide and treating physician-independent data acquisition as well as the large sample size of adult patients with a very rare congenital malformation. Unfortunately, more detailed analyses on sexual function and current psychosocial situation, for example correlation of data with clinical symptoms such as continence status, was not possible as data were mainly not answered by patients. CONCLUSION To improve the quality of life of patients with BEEC/BE, treatment and follow-up should emphasize physical but also psychological care in these patients. Physicians should further re-evaluate their preconceptions and should take care of the patients throughout their lives.
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Affiliation(s)
- Weon Park
- Helios Center for Pediatric Surgery, Berlin, Germany
| | - Nadine Zwink
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Germany
| | - Wolfgang H Rösch
- Department of Pediatric Urology, University Medical Center Regensburg, Germany
| | - Eberhard Schmiedeke
- Department of Pediatric Surgery and Urology, Centre for Child and Youth Health, Klinikum Bremen-Mitte, Germany
| | - Raimund Stein
- Division of Pediatric Urology, Department of Urology, University of Mainz, Medical School, Germany
| | - Dominik Schmidt
- Department of Pediatric Surgery, Charité Universitätsmedizin Berlin, Germany
| | - Meinolf Noeker
- Department of Pediatrics, Pediatric Psychology, University of Bonn, Germany
| | - Ekkehart Jenetzky
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Germany; Department for Child and Adolescent Psychiatry, Johannes Gutenberg-University, Germany
| | - Heiko Reutter
- Institute of Human Genetics, University of Bonn, Germany; Department of Neonatology, Childrens' Hospital, University of Bonn, Germany
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10
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Walder R, Mouriquand P, Ruffion A, Rudigoz RC. [Ileocystoplasty, pregnancy and delivery]. ACTA ACUST UNITED AC 2015; 45:380-7. [PMID: 25980901 DOI: 10.1016/j.jgyn.2015.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 02/06/2015] [Accepted: 04/15/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Bladder augmentation is commonly used in neurological and other congenital anomalies of the lower urinary tract. In pregnant women, this reconstructive surgery may affect pregnancy and delivery. The obstetrical consequences of these urological procedures are scarcely reported in literature. MATERIAL AND METHOD Eight pregnancies in 6 pregnant women with ileocystoplasty were followed in our institution between 1998 and 2014. RESULTS Urinary tract infections were the most frequent undesirable record event (5 patients, 7 pregnancies). Obstetrical complications were not more frequent compared to common pregnancies. Delivery was programmed at 37WA. Cesarean section was favoured in this group although natural delivery is possible. CONCLUSION Urological complications were the major problem in this series. The type of delivery depends on the past surgical history and the obstetrical prognosis.
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Affiliation(s)
- R Walder
- Pôle de gynécologie-obstétrique, hôpital de la Croix-Rousse, 103, boulevard de la Croix-Rousse, 69004 Lyon, France.
| | - P Mouriquand
- Service de chirurgie urologique pédiatrique, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69500 Bron, France.
| | - A Ruffion
- Service d'urologie, hôpital Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
| | - R-C Rudigoz
- Pôle de gynécologie-obstétrique, hôpital de la Croix-Rousse, 103, boulevard de la Croix-Rousse, 69004 Lyon, France.
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11
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Reddy SS, Inouye BM, Anele UA, Abdelwahab M, Le B, Gearhart JP, Rao PK. Sexual Health Outcomes in Adults with Complete Male Epispadias. J Urol 2015; 194:1091-5. [PMID: 25916676 DOI: 10.1016/j.juro.2015.04.082] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE Complete male epispadias is a rare congenital anomaly characterized by failed closure of the entire penopubic dorsal urethra. Epispadias repair is typically performed during infancy, and resultant genitourinary abnormalities can have a marked impact on adult life. We assess long-term post-reconstruction sexual health and fertility outcomes in adults with complete male epispadias. MATERIALS AND METHODS A total of 132 patients 18 years or older with complete male epispadias who had undergone reconstruction were identified from a prospectively maintained, institutionally approved database. Patients who could be contacted were asked to complete a telephone survey regarding sexual function. Reconstructive history and clinical details were obtained by chart/database review. RESULTS Of 132 patients with complete male epispadias 74 met inclusion criteria and 15 (20%) completed the questionnaire. Seven patients (47%) reported currently being in a relationship. Although 12 patients (80%) reported overall satisfactory sexual intercourse, 11 (73%) admitted to 1 or more problems with sexual function, including abnormal ejaculation (53%), diminished sensation (20%) and difficulty maintaining an erection (20%). When questioned regarding the importance of fertility on a scale of 0 to 5 using a Likert-type item the response of 10 patients (67%) was 4 points or greater. Five patients (33%) reported having impregnated a sexual partner. Although 4 patients (27%) had suspicion of fertility problems, only 2 (13%) reported having abnormal semen analyses. CONCLUSIONS This is one of few studies examining post-reconstruction sexual health and function in adults with complete male epispadias. Although small, our study demonstrates that patients are able to engage in relationships, participate in sexual intercourse and impregnate their partners. These results highlight sexual concerns and outcomes that may be of use when counselling patients with complete male epispadias and their families.
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Affiliation(s)
- Sunil S Reddy
- James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Brian M Inouye
- James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Uzoma A Anele
- James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Mahmoud Abdelwahab
- James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Brian Le
- James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - John P Gearhart
- James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Pravin K Rao
- James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
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Abstract
Despite advances in the management of exstrophy epispadias complex (EEC), the quality of life of these patients is far from good. The post-operative period is complicated by numerous and variable events - infection, dehiscence, upper tract dilatation with deterioration, fistulas, stone formation and incontinence to name a few of the major complications. Redo surgery for bladder closure, bladder neck reconstruction, epispadias repair and closure of fistulas are frequently required. The current focus is on limiting the frequency and morbidity of the reconstructive procedures. A successful initial closure and early satisfactory cosmetic and functional results are gratifying for the family and the health care team, but this is only the beginning of the lifelong care necessary for bladder exstrophy (BE) patients. In this article, the long-term outcome of various treatment options and the continent procedures in BE has been reviewed, tracing the journey of these patients into adolescence and adulthood.
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Affiliation(s)
- Jai K Mahajan
- Department of Paediatric Surgery, Institute- Advanced Paediatric centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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