Prostate size and configuration in adults with bladder exstrophy

A total of 13 men born with classical bladder exstrophy underwent magnetic resonance imaging examination of the pelvis to evaluate the size and configuration of the prostate and pelvic organs. Mean patient age was 25.2 years (range 19 to 38). Of the patients 4 are voiding per urethram and 9 have undergone urinary diversion. Measurements included prostate volume, weight and maximum axial cross sectional area; pubic diastasis, and seminal vesicle size. The mean prostatic cross sectional area was 10.1 ± 3.4 cm.². The mean estimated prostatic volume and weight were 20.7 ± 8.2 cc and 21.7 ± 8.6 gm., respectively. The mean seminal vesicle length and width were 2.1 ± 0.99 and 1.1 ± 0.38 cm., respectively. The volume, weight and maximum cross sectional area of the prostate appear normal compared to published norms. In none of the patients did the prostate extend circumferentially around the urethra and the urethra was anterior to the prostate in all patients. Also, the puborectalis muscle group was widely separated and only provided lateral support of the prostate in patients who were continent and who had undergone prior posterior iliac osteotomy. Thus, the attainment of continence in this complex group of patients is multifactorial and prostate growth as evaluated by magnetic resonance imaging may not influence continence in these patients.