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Epispadias and bladder exstrophy in adults
Last reviewed: 06.07.2025
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Epispadias and bladder exstrophy in adults are very rare anomalies. The incidence is 1:118,000 in male births and 1:484,000 in female births. The ratio of male to female epispadias is 4:1.
Despite the low incidence of these malformations of the urogenital tract, the severity of the condition and the low quality of life of patients force specialists to look for optimal methods of correction and treatment. All syndromes inherent in exstrophy and epispadias are socially significant and lead to disability at a young age. These are the most severe malformations of the urogenital tract from both a clinical and social point of view, which predetermined the allocation of the principles of urogenital reconstruction in adults in a separate chapter.
Complex rehabilitation of adolescent and mature patients is complicated by changing needs and deeper social motivations. The complexity of urogenital reconstruction in adults is due to the pronounced cicatricial process, deficiency of plastic material, complex combined deformation of the cavernous bodies associated with congenital developmental anomalies and previous surgical interventions. Unfortunately, interventions performed in childhood aimed at the maximum possible isolation of the cavernous bodies (up to separating them from the inferior branch of the pubic bone) and correction of the chord according to Cantwell-Ransley do not lead to a significant increase in the length of the penis. Moreover, complete mobilization of the cavernous bodies is associated with the risk of damage to the cavernous arteries and the development of organic erectile dysfunction.
In addition, even minimal congenital deviation of the penis from the midline almost always leads to the development of sexual phobic neurosis and depression, which has been demonstrated in patients with congenital erectile deformity with a deviation angle of no more than 10-15° in patients with such extensive lesions of the genital area as in epispadias and exstrophy of the bladder in adults, the degree of neurosis and the depth of damage to the psychoemotional sphere are so significant that they have a significant impact on treatment tactics. Underestimation of changes in the psychoemotional sphere can doom to failure any attempt at surgical elimination of the primary psychotraumatic factor.
Changes in age priorities, transformation of consciousness and psyche under the influence of chronic psychotraumatic situation, numerous operations performed from the first hours of life, and almost always an extremely unfavorable social environment predetermine approaches to treatment and the choice of surgical method that differ from those in pediatric patients. Quality of life on the QoL scale is 5.2 points, life satisfaction on the LSS scale is only 25% of the maximum score (6.2). Unfortunately, survey results do not reflect the real situation of such patients. Half of them are children from orphanages, a third attend kindergartens, some cannot read and count, and only 15% graduate from school. All patients have deep neuroticism with genital fixation and severe social and sexual maladaptation against the background of syndromes of small and deformed penis, urinary incontinence.
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