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J Pediatr Urol. 2018 Aug;14(4):322.e1-322.e6. doi: 10.1016/j.jpurol.2018.05.029. Epub 2018 Jul 9.

Using social media for patient-reported outcomes: A study of genital appearance and sexual function in adult bladder exstrophy patients.

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Division of Pediatric Urology, Seattle Children's Hospital, Seattle, USA. Electronic address:
Division of Pediatric Urology, Seattle Children's Hospital, Seattle, USA.



There have been few prior studies on patient-centered outcomes of adults with bladder exstrophy; those performed have been single institution reviews. In collaboration with the Association for the Bladder Exstrophy Communities (ABeC) - an international support network for patients and families living with bladder exstrophy - an anonymous social media survey was performed of patient-reported genital appearance and erectile function.


The study evaluated the Penile Perception Score (PPS) and the International Index of Erectile Function (IIEF-15) in adult men with bladder exstrophy. It was hypothesized that scores would be significantly lower than prior reported scores for men without the condition.


After review by an anonymous patient advocate volunteer, the ABeC performed an anonymous online survey using social media.


Adult men with bladder exstrophy reported PPS, and satisfaction with penile length and axis that were lower than prior published controls (n = 54, P < 0.05). Orgasmic function, sexual desire, and overall satisfaction were also lower (n = 46, P < 0.05). There was no difference in erectile function or intercourse satisfaction compared to controls. There was an association between PPS and erectile function, intercourse satisfaction, and overall satisfaction (P < 0.05) (Summary Fig.). Respondents identified urinary issues, genital appearance, and sexual function as the three main domains that warranted further research.


This study found that PPS and IIEF-15 were low in adult men with bladder exstrophy, and worse perception of genital appearance was associated with worse sexual satisfaction. Social media is a novel tool for patient-centered outcomes research, and continued collaboration with patients and patient advocate groups is vital.


Bladder exstrophy; International index of erectile function; Patient-centered outcomes; Penile perception score; Sexual function; Social media

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