title: Sexual Function, Social Integration and Paternity of Males with Classic Bladder Exstrophy following Urinary Diversion.
abstract: OBJECTIVE
  We evaluated patients with classic bladder exstrophy and a history of urinary diversion for sexual function, social integration and paternity.
  
  
  METHODS
  We reviewed the medical records of males older than 18 years with exstrophy who had undergone urinary diversion at our department between 1969 and 2014. Patients were invited for structured followup examinations and were asked to complete questionnaires relating to sexual function, social integration and paternity.
  
  
  RESULTS
  Of 79 eligible patients 39 (49%) with a mean followup of 23.8 years (range 2 to 45) were included in the study. Of the patients 41% had undergone primary urinary diversion and 59% had undergone secondary urinary diversion after failed reconstruction of the exstrophic bladder. Sexual function as measured by the International Index of Erectile Function was negatively affected in all domains, with mild to moderate dysfunction in 90% of patients. Of the patients 73% had a stable relationship and 32% were married. A high level of education had been achieved by 77% of patients. Sperm quality was poor (oligoasthenoteratozoospermia) in 71% of patients. Among the patients 11 had fathered a total of 16 healthy children.
  
  
  CONCLUSIONS
  Despite multiple reconstructive procedures of the genitourinary tract, including removal of the exstrophic bladder and subsequent urinary diversion, sexuality and paternity in this subset of patients was comparable to reported series of men in whom the bladder had been preserved. Evaluation of sexual function and fertility should be part of long-term followup, and treatment should be offered if indicated. Currently staged concepts of exstrophy repair should be applied to improve the cosmetic and functional outcomes of the genitourinary tract in patients with exstrophy.
authors.affiliation: Division of Pediatric Urology, Mainz University Medical Center, Mainz, Germany. Electronic address: peter.rubenwolf@unimedizin-mainz.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Rubenwolf
authors.affiliation: Department of Urology, Mainz University Medical Center, Mainz, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Thomas
authors.affiliation: Department of Urology, Mainz University Medical Center, Mainz, Germany.
authors.forename: Joachim W
authors.initials: JW
authors.lastname: Thüroff
authors.affiliation: Division of Pediatric Urology, Mainz University Medical Center, Mainz, Germany.
authors.forename: Raimund
authors.initials: R
authors.lastname: Stein
mesh_terms: D000328:Adult; D001746:Bladder Exstrophy / Q000601:surgery*; D007172:Erectile Dysfunction / Q000209:etiology*; D006801:Humans; D007248:Infertility, Male / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010334:Paternity; D012919:Social Behavior; D011795:Surveys and Questionnaires; D014547:Urinary Diversion / Q000009:adverse effects*
keywords: bladder exstrophy; fertility; physiological; sexual dysfunction; urinary diversion