The pelvic musculoskeletal and genitourinary defects associated with bladder exstrophy-epispadias complex (BEEC) may result in variations in the anatomy of the pelvic floor musculature and pelvic organs, which may affect the urinary continence and sexual function of BEEC patients following primary repair. Therefore, we evaluated the anatomy of bladder, prostate, penile vasculature and pelvic floor muscle of adult males who had experienced BEEC repair during their childhood, using 3-Tesla pelvic magnetic resonance imaging (MRI).

In a retrospective study, we reviewed the database of the post pubertal male patients who underwent repair of BEEC at our tertiary center from 1990 till 2006. Those patients were invited to perform 3-Tesla pelvic MRI to delineate the pelvic anatomy after the multiple reconstructive surgeries that might compromise the neurovascular supply of the pelvic organs and affect the pelvic musculature.

A total of 21 male patients with mean ages 21.7 ± 5.2 years old, were included. Seven patients underwent repair as a primary procedure, while 14 patients had redo procedures. Coronal images of pelvic MRI showed bladder neck to erectile body distance, iliococcygeal angle, prostate diameter, corpus cavernosum diameter, inter-corporeal diameter, neurovascular bundle, penile vasculature and length, symmetry between both corporeal bodies and depth of bladder neck from anterior skin (Table 1). Axial images revealed iliac, ischial, obturator internus, puborectalis angles, posterior anal distance, bladder neck distance, anteroposterior diameter of the prostate, symphyseal and erectile diastasis distance, while sagittal images showed sacral anal and sacral bladder neck angles (Table 2).

The study included a total of 21 male patients who had undergone repair of BEEC. Primary repair was performed only in 7 patients, while the remaining 14 patients had redo procedures. All patients underwent pelvic MRI to delineate the pelvic anatomy after these multiple reconstructive surgeries. Coronal images of pelvic MRI showed bladder neck to erectile body distance, iliococcygeal angle, prostate diameter, corpus cavernosum diameter, inter-corporeal diameter, neurovascular bundle, penile vasculature and length, symmetry between both corporeal bodies and depth of bladder neck from anterior skin. Axial images revealed iliac, ischial, obturator internus, puborectalis angles, posterior anal distance, bladder neck distance, anteroposterior diameter of the prostate, symphyseal and erectile diastasis distance, while sagittal images showed sacral anal and sacral bladder neck angles.

MRI can accurately delineate the anatomy of the pelvic organs, neurovascular bundles and musculature in adult males who had undergone BEEC repair during their childhood, so it may reflect the urinary continence and sexual function of those patients.