Resultant hypospadias after epispadias repair in bladder exstrophy patients: a difficult surgical task with high complication rate

Penile repair in patients with epispadias-exstrophy complex-can we prevent resultant hypospadias?

PURPOSE

Male genitalia reconstruction in patients with exstrophy-epispadias complex often leads to secondary hypospadias, thus requiring additional surgery and resulting in possible complications. We describe a technique of male epispadias repair to prevent resultant hypospadias.

MATERIALS AND METHODS

The complete penile disassembly technique is modified by multiple Z-plasties, which enable creation of a funnel-like bladder neck and urethral plate lengthening. A total of 29 patients 2 months to 12 years old presenting with pure epispadias and bladder exstrophy were treated with this technique between 2004 and 2011. These patients were compared to 19 patients 1 day to 11 years old with exstrophy-epispadias treated with the standard penile disassembly technique between 2000 and 2004.

RESULTS

Outcome measures were urethral orifice position, penile length and complications. There was no statistically significant difference between the 2 groups regarding penile length or complications. In the study group the urethra reached the tip of the glans in all patients, whereas the creation of intentional hypospadias was necessary in 6 patients (31.5%) in the control group (p <0.05).

CONCLUSIONS

The modified technique was effective in obtaining appropriate meatal location without decreasing the penile length. The complication rate was not changed. Creation of resultant hypospadias at genitalia reconstruction in male epispadias should strongly be prevented.

Epispadias repair: functional outcome of complete disassembly

PURPOSE OF REVIEW

Complete penile disassembly (CPD) is a widely utilized procedure for epispadias repair. The rarity of the anomaly and limited number of patients in published series limit our ability to fully evaluate the outcome of such a technique.

RECENT FINDINGS

We reviewed the literature for published data on CPD. We looked at different complications of the procedure and the main modifications to alleviate such complications. We looked at functional data on the effect of such a technique on erectile function. This review should be helpful in parents/patient counseling. Future areas for research are suggested.

SUMMARY

CPD is a safe and highly successful technique for epispadias repair in infants, boys and adults. There is an ongoing concern with the procedure in neonates. The procedure has a satisfactory outcome when performed for isolated epispadias. In the exstrophy population, long-term data are required to evaluate the outcome of the technique on urinary continence and sexual functions.