Issues with the external and internal genitalia in postpubertal females born with classic bladder exstrophy: a surgical series.
OBJECTIVE
To report our experience with surgical management of gynecological issues in postpubertal female patients born with classic bladder exstrophy (BE).


METHODS
Retrospective review of clinical charts.


METHODS
Tertiary pediatric urology unit.


METHODS
16 postpubertal female BE patients.


METHODS
Cosmetic surgery to the external genitalia, widening of vaginal introitus, and treatment of pelvic organ prolapse.


METHODS
patient satisfaction and additional gynecological problems during follow-up.


RESULTS
Eight cases (14-43 years old) underwent cosmetic procedures. All resulted in improved cosmesis, but one case complained of reduced erogenous sensitivity after clitoridoplasty. Five cases (17-20 years old) underwent widening of the vaginal introitus. The modification was as short as possible to avoid any foreshortening of the dorsal vaginal wall. Three cases 33-45 years old presented with pelvic organ prolapse. All were sexually active. One had already given birth. All the three had previously been submitted elsewhere to a posterior vaginal cutback and one to hysterectomy. Two are still awaiting further treatment due to recurrent prolapse.


CONCLUSIONS
Female BE patients can seek advice to improve the appearance of the external genitalia at any ages. Clitoridoplasty should be considered carefully, because it may harm erogenous sensitivity. Problems with the vaginal introitus typically present at around 20 years of age, probably when BE patients become sexually active. Opening too widely the introitus can cause a foreshortening of the posterior vaginal wall, predisposing to pelvic organ prolapse. Treatment of pelvic organ prolapse is difficult.
Castagnetti
Marco
M
Section of Paediatric Urology, Department of Oncological and Surgical Sciences, University Hospital of Padova, Padua, Italy. marcocastagnetti@hotmail.com
Berrettini
Alfredo
A
Zhapa
Evisa
E
Rigamonti
Waifro
W
Zattoni
Filiberto
F
D000293:Adolescent; D000328:Adult; D001746:Bladder Exstrophy / Q000150:complications* / Q000601:surgery; D005260:Female; D005836:Genitalia, Female / Q000002:abnormalities* / Q000601:surgery*; D006801:Humans; D056887:Pelvic Organ Prolapse / Q000150:complications / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D055815:Young Adult