Semen Analysis and Transrectal Ultrasound Findings in Men with Bladder Exstrophy
Although it has been reported that women with bladder exstrophy have relatively normal potential for fertility, little has been reported about such potential in men with this disorder. In 1991, Hamper et al. evaluated 7 men with bladder exstrophy with transrectal ultrasound (TRUS) and found that, although 6 had prostates and seminal vesicles, only 2 showed a normal appearance to these structures. In 1979, Lattimer et al. reported on semen analyses from 9 men with bladder exstrophy and found that 7 were oligo- or azoospermic. Since no study to date has simultaneously examined semen analyses, TRUS findings, and hormonal parameters in men with bladder exstrophy, we describe this data from 4 men with this disorder.
Semen analyses were significant for a pH greater than 8.5 and a low semen volume in all patients. Sperm density and motility ranged from aspermic to normal. TRUS findings were significant for prostates that ranged from cystic to small to normal. Most patients had abnormal distal insertion of the seminal vesicles/ejaculatory ducts into the prostate. FSH concentrations were normal in 2 of 4 patients while testosterone levels were all normal.
In conclusion, fertility potential in male exstrophy patients appears variable. The major finding here is the abnormal distal insertion of the seminal vesicles/ejaculatory ducts into the prostate associated with an abnormally high seminal pH. Three possible explanations for this are: 1) a developmental defect in this disorder may involve hindered growth of prostatic tissue, accounting for the elevated seminal pH, low semen volume, and abnormal seminal vesicle-prostatic insertion; 2) alterations in anatomy could be secondary surgical procedures undergone by these patients; and 3) functional changes in the prostate could result from multiple episodes of epididymitis.
KeywordsSemen Analysis Seminal Vesicle Ejaculatory Duct TRUS Finding Bladder Exstrophy
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