Complete male epispadias: genital reconstruction and achieving continence.
We report on 15 patients who were primarily treated for complete male epispadias at our institution since 1975. Repair of epispadias was performed using a modified Young urethroplasty in 13 patients and a Cantwell-Ransley urethroplasty in 2. In addition, 2 patients underwent a Cantwell-Ransley urethroplasty with chordee repair after a previous Young urethroplasty failed. Bladder capacity increased from a mean of 50 cc before repair to 92 cc after urethroplasty. A urethrocutaneous fistula developed in 6 cases, including 5 Young repairs and 1 Cantwell-Ransley. Three fistulas resolved spontaneously and there were no urethral strictures. Bladder neck reconstruction was performed in 11 patients. Time to initial continence ranged from 21 days to 6 months (mean 3 months) postoperatively. All patients attained daytime continence in a mean of 9 months (range 21 days to 24 months) after bladder neck reconstruction, including 9 of 11 (82%) who achieved total day and night continence. Mean followup was 7 years (range 1 to 10). Modern treatment of complete male epispadias allows for an excellent genital appearance and achievement of urinary continence.
Ben-Chaim
J
J
Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland 21287-2101, USA.
Peppas
D S
DS
Jeffs
R D
RD
Gearhart
J P
JP
D002675:Child, Preschool; D017577:Cutaneous Fistula / Q000453:epidemiology; D004842:Epispadias / Q000453:epidemiology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D010413:Penis / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors; D014521:Urethra / Q000601:surgery*; D014522:Urethral Diseases / Q000453:epidemiology; D001743:Urinary Bladder / Q000601:surgery*; D014548:Urinary Fistula / Q000453:epidemiology; D014549:Urinary Incontinence / Q000517:prevention & control*