Long-term outcome (38-69 years) of patients born with classical bladder exstrophy
Purpose To assess social, psychosexual and uro/nephrological long-term outcome in patients born with a bladder exstrophy Material and methods 42 consecutive patients born between 1937 and 1968 were treated with ureterosigmoidostomies (Mathisen) and genital reconstruction because of classical bladder exstrophy were identified and reviewed including personal interview, clinical examination, renal imaging (MRI) and renal function assessment. Results 26 patients were male, 16 female. 7 patients were lost to follow-up. In addition 5 girls had died as infants, 1 young man had a fatal motorbike accident and 1 young women died from an unrelated (?)tumour and heroin abuse. 2 patients refused to partake in the study and 1 was too sick to participate (pneumonia). Of the remaining 25 patients (21 male and 4 female) 13 still had ureterosigmoidostomies (all are continent), 11 had some form of a conduit or pouch and 1 has cutaneus ureterostomies. Renal function (n = 21) was normal in 18 patients, 3 had a serum-Crea >200 and 2 had undergone renal transplantation. All but 5 patients had regular check-sigmoidoscopies, 5 had polyps resected, 1 patient suffered from a malignant tumour in the sigmoid, another had a papillary urethral tumour. 21 patients were married, 8 (7 males, 1 female) had their own children. 14 reported normal sexual experiences during puberty, 5 "delayed" and 6 never tried or had disappointing sexual experiences. As adults 14 reported normal sexual activity, 3 intercourse only possible in certain positions, 4 had never tried, 2 impossible, 1 painful and 1 refused to answer. All but 1 of the males reported normal erections (2 with Viagra) and 13 reported normal ejaculations. Socially all patients but 1 were well integrated and fully employed in good positions. Subjectively (from my point of view) they were the most interesting people to interview. Conclusions Patients born with a bladder exstrophy and treated with ureterosigmoidostomies were able to lead very successful lives both socially and sexually.