Semen Analysis and Transrectal Ultrasound Findings in Men with Bladder Exstrophy

  • Terry W. Hensle
  • Erik T. Goluboff
  • Harry Fisch


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.


Semen Analysis Seminal Vesicle Ejaculatory Duct TRUS Finding Bladder Exstrophy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Gearhart JP and Jeffs RD: Exstrophy of the bladder, epispadias, and other bladder anomalies. In; Campbell’s Urology. Edited by PC Walsh, AB Retik, TA Stamey and ED Vaughan. Philadelphia: WB Saunders, vol. 2, pp. 1772–1821, 1992.Google Scholar
  2. 2.
    Young HH: Exstrophy of the bladder: The first case in which a normal bladder and urinary control have been obtained by plastic operation. Surg Gynecol Obstet 74: 729, 1942.Google Scholar
  3. 3.
    Woodhouse CRJ, Ransely PG and Williams DI: The patient with exstrophy in adult life. Br J Urol 55: 632, 1983.PubMedCrossRefGoogle Scholar
  4. 4.
    Lattimer JK, MacFarlane MT and Puchner PJ: Male exstrophy patients: A preliminary report on the reproductive capability. Trans Am Assoc Genitourinary Surgeons 70: 42, 1979.Google Scholar
  5. 5.
    Burbige KA, Hensle TW, Chambers WJ, Leb R and Jeter KF: Pregnancy and sexual function in women with bladder exstrophy. Urology 28: 12, 1986.PubMedCrossRefGoogle Scholar
  6. 6.
    Lattimer JK, Beck L and Yeaw S: Long-term followup after exstrophy closure: Late improvement and good quality of life. J Urol 119: 664, 1978.PubMedGoogle Scholar
  7. 7.
    Hamper UM, Gearhart JP, Danhert WF, Smith S and Jeffs RD: Bladder exstrophy-epispadias complex: Pro-static evaluation by transrectal ultrasonography. Prostate 19: 133, 1991.PubMedCrossRefGoogle Scholar
  8. 8.
    World Health Organization. Laboratory manual for the examination of human semen and semen-cervical mucous interaction. 3rd ed. Cambridge: The Press Syndicate of the University of Cambridge, 1991.Google Scholar
  9. 9.
    Jarow JP: The role of ultrasonography in the evaluation of the infertile male. Semin Urol 12: 274, 1994.PubMedGoogle Scholar
  10. 10.
    Hanna MK and Williams DJ: Genital function in males with vesical exstrophy and epispadias. Br J Urol 44: 1969, 1972.Google Scholar
  11. 11.
    Gearhart JP, Yang A, Leonard MP, Jeffs RD and Zerhouni EA: Prostate size and configuration in adults with bladder exstrophy. J Urol 149: 308, 1993.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1999

Authors and Affiliations

  • Terry W. Hensle
    • 1
    • 2
  • Erik T. Goluboff
    • 1
  • Harry Fisch
    • 1
  1. 1.Department of UrologyBabies and Children’s Hospital Columbia-Presbyterian Medical CenterNew YorkUSA
  2. 2.Babies Hospital, Columbia-Presbyterian Medical CenterNew YorkUSA

Personalised recommendations