Growth of Secondary Sex Organs:
The configuration of the prostate is abnormal in
the patients with exstrophy. In spite of demonstrating normal growth
of the prostate and seminal vesicles, the prostate does not surround
the urethra. There is some data indicating that the growth of the
prostate in patients with epispadias may contribute to development
of later continence, but this has not been noted in the patients with
exstrophy.
Malignancy:
Two latent malignancies have come to light as a
result of the increased survival of patients with exstrophy. Adenocarcinoma
of the bladder was noted to constitute 80% of the bladder cancers
in the patients with exstrophy. This may be due to chronic irritation
or from rests of gastrointestinal tissue in the exstrophied tissue.
Adenocarcinoma of colon adjacent to the ureterointestinal anastomosis
is another frequent cancer noted in those patients who had performance
of ureterosigmoidostomy as a urinary diversion. The mean latency interval
is 10-17 years with early metastasis noted.
Prostate cancer has been noted in these patients
and PSA measurements must be performed in adult life.
Fertility:
Male fertility in classic exstrophy has been rarely
documented. Abnormalities on sperm count may contribute to this lack
of fertility. Retrograde ejaculation may also account for some of
the lower sperm counts noted in the males. Several males in our exstrophy
group have fathered children with modern reproductive technology and
so far all have been normal, robust infants.
Pregnancy:
Pregnancy has been reported in females with exstrophy,
however there is a high incidence of uterine prolapse in these patients.
Women who have had prior urinary diversion can be delivered vaginally.
However, those with functional closure should have cesarean section
to avoid stressing the pelvic floor.
Sexual Function:
Libido is normal in males and females. Males have normal
erections and orgasmsand females have orgasms.
Reference:
- John P. Gearhart, Robert D. Jeffs: Exstrophy
of the Bladder, Epispadias and other Bladder Anomalies in Campbell's
Urology, 7th Edition. Eds. Walsh PC, Retik AB, Stamey TA, Darracott
Vaughan E, Jr., WB Saunders Co. Vol. 2 1772-1821.
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