[Surgical repair of male epispadias by the Cantwell-Ransley procedure: technical aspects and functional results in a series of 40 patients].
From 1989 to 1997, 40 patients underwent primary (n = 29) or a secondary (n = 11) epispadias repair according to the Cantwell Ransley Procedure. 23 patients had bladder exstrophy, 6 had penopubic epispadias, and 11 had penile epispadias. The mean age at surgery was 5 years (1-28 years); 23 patients were prepubertal and 17 were postpubertal. The procedure associated an IPGAM meatoplasty, ventral transposition of the urethra, and dorsal rotation and approximation of the corpora with (16) or without (24) caverno-cavernostomy. With a mean follow-up of 4 years, 19 patients (47.5%) achieved a good cosmetic and functional result after a single procedure. 18 patients (45%) developed complications that required minor revision (8 patients) or a more major procedure (10 patients). Finally 3 patients (7.5%) had a complete failure. 3 patients also had a loss of continence (complete in one case) after the procedure. The complication rate was slightly higher in the postpubertal group (58%) than in the prepubertal group (47%). A prior urinary diversion did not increase the complication rate. All 17 patients in the postpubertal group reported satisfactory erections. All 16 patients who had minor to major urethral complications had previously undergone transection of the urethral plate. Overall 35 patients (87.5%) achieved a satisfactory cosmetic and functional result. The Cantwell Ransley procedure is an excellent procedure for the repair of male epispadias. However the complication rate is significant, mainly related to previous operations compromising the blood supply to the posterior penile urethra.
Lottmann
H
H
Service d'Urologie de l'Enfant et de l'Adolescent, Hôpital Saint-Joseph, Paris.
Yacouti
M
M
Melin
Y
Y
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004842:Epispadias / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010410:Penile Erection; D011183:Postoperative Complications