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An Initial Evaluation of Pelvic Floor Function and Quality of Life of Classic Bladder Exstrophy Patients Who Have Undergone Ureterosigmoidostomy
Jennifer Miles-Thomas, The Johns Hopkins Hospital, Baltimore, MD; Susan Gearhart, The Johns Hopkins Hosptial, Baltimore, MD; John P. Gearhart, The Johns Hopkins Hospital, Baltimore, MD
Purpose: Classic bladder exstrophy is characterized by displaced pelvic floor musculature and significant skeletal and genitourinary defects. There is a paucity of data evaluating long-term pelvic floor function in exstrophy patients following ureterosigmoidostomy. This study is an initial attempt to evaluate the incidence of urofecal incontinence, pelvic organ prolapse, and overall quality of life in patients who have previously undergone ureterosigmoidostomy. Methods: Fifty-two participants who underwent ureterosigmoidostomy between the years 1937 – 1990 were identified through members of the Ureterosigmoidostomy Association and the Johns Hopkins Bladder Exstrophy Database. Questionnaires approved by the Institutional Review Board was mailed to all participants. Follow-up contact was made at 3 weeks. Data were analyzed using SigmaStat 3.0 (SPSS, Inc.,Chicago, IL).
Results: Eighty-three percent (n = 52) participants with a mean age of 44.4 (range 14–73 years) and mean number of years of 40.9 (range 14–65 years) following ureterosigmoidostomy responded. The prevalence of daily urine incontinence was 48%, the prevalence of daily fecal incontinence was 26%, while the prevalence of weekly combined urofecal incontinence was 63%. The incidence of pelvic organ prolapse in this cohort of patients was 47.6 percent . There was no significant difference in incontinence among gender or presence of pelvic organ prolapse. Older women (> 40 years) were 2.4 times more likely to have urofecal incontinence (OR 2.4, 95% CI 0.61 – 9.45). Eighty-seven percent of respondents reported good to excellent quality of life and would repeat the procedure. Conclusions: In these patients with complex pelvic musculoskeletal anomalies, a significant risk of urofecal incontinence and pelvic organ prolapse exists. Modern imaging and surgical techniques which have been recently applied to patients with classic bladder exstrophy may allow for improved pelvic floor function. Long-term follow up studies are needed to better understand the role of pelvic floor musculature in this complex birth defect.
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