Objective: To define the additional value of intracytoplasmatic sperm injection (ICSI).
Design: Descriptive clinical study.
Setting: Male patients with bladder exstrophy in an academic setting.
Patient(s): Three male patients in a stable relationship, desirous to have their own children. They were born with bladder exstrophy and had undergone surgical reconstruction.
Intervention(s): The ICSI procedure.
Main outcome measure(s): Number of pregnancies.
Result(s): Each of the three men presented a different way of producing sperm. The first male patient had no ejaculation, and sperm cells were retrieved by percutaneous sperm aspiration (PESA). The second could ejaculate with the production of sperm cells, and the third had no ejaculation but collected prostatic fluid by catheterization of a cutaneous fistula; this fluid contained sperm cells. Their partners all had undergone a successful ICSI procedure.
Conclusion(s): Nowadays, men with bladder exstrophy reach adult age and therefore express the desire to parent their own children. Careful attention to genital reconstruction has to be given to enhance the possibility to antegrade production of sperm. In cases when this is not possible, PESA/testicular sperm extraction in combination with ICSI offer an added opportunity for these couples.