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Epispadia and bladder exstrophy in adults
Last reviewed: 23.04.2024
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Epispadia and bladder exstrophy in adults are very rare anomalies. Frequency of occurrence is 1: 118 000 among born boys and 1: 484 000 - among girls. The ratio of male and female epispadias is 4: 1.
Despite the low incidence of these malformations of the urogenital tract, the severity of the condition and the poor quality of life of the patients force the specialists to search 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 both from a clinical and a social point of view, which predetermined the isolation of the principles of urogenital reconstruction in adults into a separate chapter.
Complexities of complex rehabilitation of patients of adolescence and adulthood are associated with changing needs and deeper social motivations. The complexity of urogenital reconstruction in adults is due to the pronounced cicatricial process, the lack of plastic material, the complex combined deformity of the cavernous bodies associated with congenital developmental anomalies and previous surgical interventions. Unfortunately, interventions aimed at the maximum possible isolation of cavernous bodies (up to their separation from the lower branch of the pubic bone) and correction of the chord along Cantwell-Ransley do not lead to a significant increase in the length of the penis. Moreover, complete mobilization of cavernous bodies is associated with a risk of damage to the cavernous arteries and the development of organic erectile dysfunction.
In addition, even a minimal inborn deviation of the penis from the midline almost always leads to the development of sexual phobic neurosis and depression, which was 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 bladder exstrophy in adults, the degree of neuroticism and the depth of damage to the psychoemotional sphere are so significant that they have a significant effect on therapeutic tactics. Underestimation of changes in the psychoemotional sphere can doom to failure any attempt to promptly eliminate the primary psychotraumatic factor.
Change in age priorities, the transformation of consciousness and psyche under the influence of a chronic psychotraumatic situation, numerous operations conducted from the first hours of life, and almost always an extremely unfavorable social environment predetermines approaches to treatment and the choice of an operative method, different from those in children of childhood. 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, the polls do not reflect the real situation of such patients. Half of them are inmates of orphanages, one third attend kindergartens, some do not know how to read and count, and only 15% finish school. In all patients, against the background of small and deformed penis syndromes, urinary incontinence is marked by deep neuroticism with genital fixation and severe social and sexual maladaptation.
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