title: Issues with the external and internal genitalia in postpubertal females born with classic bladder exstrophy: a surgical series.
abstract: 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.
authors.affiliation: Section of Paediatric Urology, Department of Oncological and Surgical Sciences, University Hospital of Padova, Padua, Italy. marcocastagnetti@hotmail.com
authors.forename: Marco
authors.initials: M
authors.lastname: Castagnetti
authors.forename: Alfredo
authors.initials: A
authors.lastname: Berrettini
authors.forename: Evisa
authors.initials: E
authors.lastname: Zhapa
authors.forename: Waifro
authors.initials: W
authors.lastname: Rigamonti
authors.forename: Filiberto
authors.initials: F
authors.lastname: Zattoni
mesh_terms: 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