title: Genital prolapse in adult women with classical bladder exstrophy.
abstract: OBJECTIVE
  The aim of this paper is to study the incidence and risk factors for genital prolapse in adult women with bladder exstrophy and to describe the long-term outcome of the Gore-Tex wrap procedure for genital prolapse.
  
  
  METHODS
  A retrospective observational study on adult women with classical bladder exstrophy in a tertiary referral centre for disorders of sex development, including complex urogenital anomalies. Medical notes were reviewed and a confidential postal questionnaire on urinary continence and symptoms of prolapse was carried out.
  
  
  RESULTS
  Fifty-two women with bladder exstrophy and a mean age of 39 years (range 23 to 63) were identified, of whom 27 patients (52%) developed pelvic organ prolapse. Twenty-three out of 27 (85%) were treated surgically while only 4 patients were managed expectantly. Risk factors for prolapse included pregnancy in 10 (37%) patients and introitoplasty in 1 patient (4%). Of the 23 women treated surgically, 16 (70%) were treated using a Gore-Tex wrap, while 7 had other surgical procedures including colposuspension and hysterosacrocolpopexy. In the Gore-Tex wrap group, 12 out of 16 patients (75%) had had a successful result after the first repair compared with 2 out of the 7 patients (28%) in the group treated using other procedures. Mean follow-up was 8 years (range 1-15). One patient developed an infection after the procedure and another patient had Gore-Tex erosion.
  
  
  CONCLUSIONS
  Prolapse is a common gynaecological complaint in adult women with bladder exstrophy and the majority will require treatment. At present the Gore-Tex wrap offers good results with a low rate of serious complications.
authors.affiliation: Elizabeth Garrett Anderson UCL Institute of Women's Health, University College London Hospitals, 250 Euston Road, London NW1 2PG, UK. rolanakhal@hotmail.com
authors.forename: Rola S
authors.initials: RS
authors.lastname: Nakhal
authors.forename: Rebecca
authors.initials: R
authors.lastname: Deans
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Creighton
authors.forename: Dan
authors.initials: D
authors.lastname: Wood
authors.forename: Christopher R J
authors.initials: CR
authors.lastname: Woodhouse
mesh_terms: D000293:Adolescent; D000328:Adult; D001746:Bladder Exstrophy / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000209:etiology* / Q000601:surgery*; D011138:Polytetrafluoroethylene; D012008:Recurrence; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology; D055815:Young Adult
chemical_list: D011138:Polytetrafluoroethylene