Genital and reproductive function in males after functional reconstruction of the exstrophy-epispadias complex--long-term results.

OBJECTIVES: Genital and reproductive function have a strong effect on the quality of life of adolescent and adult male patients with the exstrophy-epispadias complex (EEC). According to the limited available data, early exstrophy reconstruction, as well as recurrent infectious or operative trauma, have been responsible for the low fertility rates.

METHODS: We evaluated 21 adult male patients with EEC. Of the 21 patients, 17 had undergone single-stage reconstruction, 1 had undergone a staged approach, 2 had primarily undergone urinary diversion, and 1 had only undergone external genital reconstruction of epispadias. All were evaluated with a semistructured questionnaire, clinical examination, ultrasonography, and hormonal and semen analyses.

RESULTS: All patients reported erections, and 19 were sure about ejaculation. Of the 21 patients, 18 patients proved antegrade and 1 retrograde ejaculation; 2 patients were not able to retrieve their specimen. Fifteen patients had a regular testicular size, and four had unilateral and two bilateral small testes. Four had irregular intratesticular ultrasound findings. Of these 4 patients, 1 had a testicular intraepithelial neoplasia that was treated with radiotherapy. The hormonal analysis findings were normal for 17 patients and 4 had elevated follicle-stimulating hormone levels. The semen analysis showed normozoospermia in 3, asthenozoospermia in 5, oligo-asthenozoospermia in 6, and azoospermia in 5 patients. The seminal parameters included fructose 1441.8 microg/mL (normal 1200-4500), zinc 43.3 microg/mL (normal 70-250), and alpha-glucosidase 19.13 mU/mL (normal >20).

CONCLUSIONS: Single-stage reconstruction with consequent placement of the colliculus seminalis in the posterior urethra results in normal ejaculation in 94.1% of patients with EEC. Because of the severely impaired sperm quality and hormonal findings, patients with EEC should be offered adequate diagnostic and treatment options.