title: Bladder exstrophy and male fertility: pregnancies after ICSI with ejaculated or epididymal sperm.
abstract: OBJECTIVE
  To define the additional value of intracytoplasmatic sperm injection (ICSI).
  
  
  METHODS
  Descriptive clinical study.
  
  
  METHODS
  Male patients with bladder exstrophy in an academic setting.
  
  
  METHODS
  Three male patients in a stable relationship, desirous to have their own children. They were born with bladder exstrophy and had undergone surgical reconstruction.
  
  
  METHODS
  The ICSI procedure.
  
  
  METHODS
  Number of pregnancies.
  
  
  RESULTS
  Each of the three men presented a different way of producing sperm. The first male patient had no ejaculation, and sperm cells were retrieved by percutaneous sperm aspiration (PESA). The second could ejaculate with the production of sperm cells, and the third had no ejaculation but collected prostatic fluid by catheterization of a cutaneous fistula; this fluid contained sperm cells. Their partners all had undergone a successful ICSI procedure.
  
  
  CONCLUSIONS
  Nowadays, men with bladder exstrophy reach adult age and therefore express the desire to parent their own children. Careful attention to genital reconstruction has to be given to enhance the possibility to antegrade production of sperm. In cases when this is not possible, PESA/testicular sperm extraction in combination with ICSI offer an added opportunity for these couples.
authors.affiliation: Department of Urology, University Medical Centre Nijmegen, St. Radboud, Nijmegen, The Netherlands. k.d'hauwers@uro.umcn.nl
authors.forename: Kathleen W M
authors.initials: KW
authors.lastname: D'Hauwers
authors.forename: Wouter F J
authors.initials: WF
authors.lastname: Feitz
authors.forename: Jan A M
authors.initials: JA
authors.lastname: Kremer
mesh_terms: D000328:Adult; D001746:Bladder Exstrophy / Q000150:complications / Q000601:surgery*; D004542:Ejaculation / Q000502:physiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007248:Infertility, Male / Q000209:etiology* / Q000628:therapy*; D008297:Male; D011247:Pregnancy; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D020554:Sperm Injections, Intracytoplasmic; D053625:Sperm Retrieval; D016896:Treatment Outcome