title: An initial evaluation of pelvic floor function and quality of life of bladder exstrophy patients after ureterosigmoidostomy.
abstract: Classic bladder exstrophy is characterized by displaced pelvic floor musculature and significant skeletal and genitourinary defects. A paucity of data exist evaluating long-term pelvic floor function in exstrophy patients after ureterosigmoidostomy. This study is an initial attempt to evaluate the prevalence of urofecal incontinence, pelvic organ prolapse, and overall quality of life in patients who have had ureterosigmoidostomies. Fifty-two individuals who underwent ureterosigmoidostomy between 1937 and 1990 were identified through the Ureterosigmoidostomy Association and the Johns Hopkins bladder exstrophy database and mailed questionnaires approved by the Institutional Review Board (Johns Hopkins). Data were analyzed with SigmaStat 3.0 (SPSS, Inc., Chicago, IL). Eighty-three percent of the subjects responded, with a mean age of 44.4 years (range, 14-73 years) and mean of 40.9 years (range, 14-65 years) after ureterosigmoidostomy. Prevalence of daily urinary and fecal incontinence was 48% (n = 20) and 26% (n = 11), respectively, whereas the prevalence of weekly combined urofecal incontinence was 63% (n = 27). The incidence of pelvic organ prolapse in this cohort was 48% (n = 20). In these patients, a significant risk of urofecal incontinence and pelvic organ prolapse exists. Long-term follow-up studies are needed to understand the role of pelvic floor musculature in this complex birth defect.
authors.affiliation: James Buchanan Brady Urological Institute, Division of Pediatric Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Miles-Thomas
authors.forename: John P
authors.initials: JP
authors.lastname: Gearhart
authors.forename: Susan L
authors.initials: SL
authors.lastname: Gearhart
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001746:Bladder Exstrophy / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D015331:Cohort Studies; D012809:Colon, Sigmoid / Q000601:surgery; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D017773:Pelvic Floor / Q000503:physiopathology*; D011788:Quality of Life; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D014547:Urinary Diversion / Q000523:psychology; D014549:Urinary Incontinence / Q000209:etiology; D014782:Visceral Prolapse / Q000209:etiology