Bladder exstrophy–epispadias complex (BEEC) refers to a rare spectrum of genitourinary malformations, for which the patients undergo a series of operations for repair during childhood, starting in infancy. The primary goals of these surgeries are urinary continence as well as cosmetically and functionally acceptable abdomen and genitalia. Although neonatal and surgical care of BEEC patients has recently advanced, urinary incontinence is still reported in 10–81% of patients. Scarring due to multiple surgeries may harm patient's body perception, genital appearance and function may also disturb the sexual life during adolescence and adulthood. Therefore, we aim to evaluate the long-term psychosexual and urinary continence outcomes of BEEC repair in males patients.

In a retrospective study, we reviewed the database of the post pubertal male patients who underwent repair of BEEC at our tertiary center from 1990 till 2006. Patients were evaluated for their social, sexual functions and urinary continence. They were considered to be continent if they were dry for more than 3 hours. History of normal voiding, clean intermittent catherization (CIC) or indwelling catheterization was taken. Patients were evaluated by International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF) questionnaire and Ejaculatory Domaine of Men Sexual Health Questionnaire (MSHQ). All patients were subjected to pad test. Pelvic magnetic resonance imaging (MRI) was also performed to assess penile length and vascularity of the corporeal bodies.

A total of 21 male patients with mean ages 21.7 ± 5.2 years old, were included in the study. Complete primary repair of BEEC was done in 18 cases and the remaining 3 cases were managed by modified staged repair. Seven patients underwent repair as a primary procedure, while 14 patients had redo procedures. Augmentation ileocystoplasty and continent cutaneous outlet were performed in 17 patients, modified rectal bladder was done in 3 patients and 1 patient had no urinary diversion. Bladder neck closure was carried out in 10 patients, while bladder neck reconstruction was reported in 11 patients after which sling procedure was offered to 3 patients and silicon injection was performed in 2 patients as secondary interventions. Complete penile disassembly was done in 18 patients, whereas modified penile disassembly was carried out in 3 patients. 80.9% of patients were voiding via CIC, 4.8% were voiding per urethra and 14.3% were urinary diverted. Median IPSS score was 6 (0–30), median IIEF score was 15 (4–25) and median ejaculatory domain of MSHQ score was 6 (0–34). Pad test results were negative in 19 patients. Pelvic MRI showed mean penile length 5.5 ± 1.96 cm and the vascularity of corporeal bodies was preserved in 20 patients.

In our study, male adolescents and adults who underwent repair of BEEC in their childhood were included. Repair was done either by complete primary repair or modified staged repair with complete or modified penile disassembly, either as a primary procedure or redo procedures. Urinary diversion in the form of augmentation ileocystoplasty and continent cutaneous outlet with bladder neck closure or reconstruction and modified rectal bladder were done in 95.2%. Secondary interventions for incontinence after bladder neck reconstruction were offered in 23.8%, such as sling procedure and silicon injection. However, 90.4% of patients were continent. Pelvic MRI showed normal vascularity of corporeal bodies in most of the patients.

Male adolescents and adults might have good long-term sexual and urinary outcomes post BEEC repair, but this may require multiple surgeries. Pelvic MRI may play an important role in the follow up of male patients after repair of BEEC.