The Obstetric and Gynaecological Complications of Bladder Exstrophy and Epispadias

Abstract

Summary A study has been made of 16 girls (14 with bladder exstrophy and 2 with epispadias) treated in the United Birmingham Hospitals since 1946 and surviving to puberty. Eight of these are married, of whom 5 have been delivered of 8 children. Ten have required some form of gynaecological surgery, with uterine prolapse as the most troublesome lesion.

Social integration, sexual behaviour and fertility in patients with bladder exstrophy —a long-term follow up

“…This can be corrected by episiotomy or vaginoplasty [4,9,13,17,22,26]. In agreement with others we recommend the definitive introitusplasty before cohabitation [4].…”

“…Bennet [4] reports on 3 of 32 men with ureterosigmoidostomy who fathered children, but data on genital reconstruction are lacking. In the study of Woodhouse [26] 6 out of 72 men have children, five of whom had undergone primary urinary diversion.…”

“…The operative techniques for reconstruction of the external genitalia in females are not problematic, however, after correction of the very narrow introitus, uterine prolapse is not uncommon [4,5,22]. This complication can be prevented or corrected by fixation of the uterus [7,26].…”

Recurrent pelvic organ prolapse in a woman with bladder exstrophy: a case report of surgical management and review of the literature

“…In utero, an aberrant division of the cloacal membrane by the urorectal fold results in the anterior displacement of the anus on the perineum. The aberrancy leads to: (1) an absence of the anterior bladder and abdominal wall; (2) failure of midline pubic symphysis fusion resulting in a 10-to 12-cm gap between the pubic rami; (3) bifid clitoris; (4) absent or attenuated urethrovesicular sphincter and urethra; (5) increased incidence of anorectal anomalies; (6) increased incidence of reproductive tract anomalies; (7) absence of the anterior portion of the levator ani muscles; and (8) anterior displacement of the vagina [1].…”

Treatment of Patients with Bladder Exstrophy or Incontinent Epispadias

“…Fertility is normal, if the internal genitalia are intact. Severe complications of pregnancy are not to be expected [1,2,12], However, uterine prolapse has occurred, espe cially after an introitus plasty [2, 12,13], Much more like ly to cause complications is the reconstruction of the external male genitalia, although the majority of the patients have reportedly been satisfied with the cosmetic results [14]. The effects of genital reconstruction on sex uality and especially fertility have been somewhat ne glected in the literature, since a very low fertility rate of only 8-18% has been reported [2,15], The latter factor represents a serious personal problem for the male pa tient.…”