To assess sexual function, quality of life, and urinary continence in young adult men with bladder exstrophy and evaluate their interrelationships.

From our IRB-approved database, the Erection Hardness Score (EHS), International Index of Erectile Function (IIEF)−15, and Short Form Health Survey were sent to adult males with bladder exstrophy. Medical and surgical histories were reviewed. Continence was assessed by catheterization, leakage, pad usage, and satisfaction.

Of 23 eligible men, 22 responded (mean age 27.6 years). Twelve patients had continent urinary diversion with Mitrofanoff appendicovesicostomy (1 closed stoma), and 10 did not have continent urinary diversion. The mean IIEF-15 score was 28.4 ± 15.6, indicating moderate sexual dysfunction. Intercourse satisfaction showed severe dysfunction, while sexual desire showed mild dysfunction. The mean EHS was 3.2 ± 1.1, indicating fairly good rigidity. The mean physical (PCS-12) and mental (MCS-12) health scores were 48.9 ± 9.4 and 38.5 ± 13.4, respectively, highlighting mental health concerns. Patients reporting recent intercourse were significantly older than those without. Older patients reported better erectile function but poorer mental well-being. Continence status and satisfaction were not associated with sexual function or quality of life, whereas redo epispadias repair was associated with better physical health.

Sexual dysfunction was present despite acceptable rigidity. Age was associated with intercourse, better erectile function, but poorer mental well-being, while redo epispadias repair was associated with better physical health. Continence did not correlate with sexual function or quality of life. Recognizing these relationships may guide treatment planning.