The exstrophy-epispadias complex: is aesthetic appearance important?

Area of Science:

• Urology
• Plastic Surgery
• Developmental Biology

Background:

• Exstrophy-epispadias complex (EEC) presents significant cosmetic and functional challenges.
• Patient body image and psychological well-being are critical aspects of EEC management.
• Multidisciplinary surgical approaches are essential for optimal EEC treatment outcomes.

Purpose of the Study:

• To highlight the importance of cosmetic appearance in treating exstrophy-epispadias complex (EEC).
• To demonstrate how surgery by experienced teams can improve long-term prognosis and patient body image.
• To evaluate the impact of reconstructive surgery on social and functional aspects of EEC patients' lives.

Main Methods:

• A cohort of 24 patients (aged 2-23 years) with EEC underwent various surgical procedures between 1978 and 2002.
• Surgical selection was guided by psychological assessments of patients and parents.
• Procedures were performed jointly by plastic surgery and pediatric urology teams with follow-up ranging from 0.33 to 7 years.

Main Results:

• Surgical interventions included abdominoplasty, repositioning of catheterization conduits, external genitalia reconstruction, penile reconstruction, and osteotomy.
• Significant improvements were observed in objective criteria such as reduced school absences and improved social interactions.
• Despite aesthetic and functional gains, sexual activity remained a challenge for the studied cohort.

Conclusions:

• Customized surgical interventions in EEC patients can yield satisfactory aesthetic results, positively impacting body image and self-esteem.
• Adolescents with EEC prioritize body image, self-esteem, sexuality, sexual function, and fertility.
• Consistent follow-up for urinary and renal complications is crucial to prevent patient loss to follow-up.