Female epispadias repair: a new 1-stage technique.
OBJECTIVE
Female epispadias is a rare anomaly. According to the literature it is usually treated with staged procedures, including bladder neck reconstruction, to achieve continence. We developed a 1-stage surgical technique that offers the possibility of achieving continence and a cosmetically normal appearance of the vulva.


METHODS
We treated 4 patients 4 months to 8 years old. The main point of the technique is to free completely the urethral plate and bladder neck from surrounding tissue. After tubularizing the urethral plate into a urethra modified needle suspension brings the bladder neck and proximal urethra into the intra-abdominal position. The pelvic floor is then reconstructed between the anterior vaginal wall and urethra. Thus, continence may be attained by intra-abdominal positioning of the bladder neck and proximal urethra as well as by pelvic floor reconstruction.


RESULTS
Of our 4 consecutive cases of primary untreated epispadias the technique proved successful in 3, while followup is too short in 1. One patient is completely dry and voids without a further procedure. Postoperatively 2 patients with 5 years or more of followup required injection of a bulking agent at the bladder neck level to achieve continence, including 1 who is damp during the day without the need to change clothes and 1 on clean intermittent catheterization twice daily because post-void residual urine volume causes recurrent urinary tract infection.


CONCLUSIONS
The described technique is promising for treating this disabling anomaly.
de Jong
T P
TP
Pediatric Renal Center, University Medical Center Utrecht, Children's Hospital, Utrecht, The Netherlands.
Dik
P
P
Klijn
A J
AJ
D002648:Child; D002675:Child, Preschool; D004842:Epispadias / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery; D001743:Urinary Bladder / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000379:methods*