Female epispadias management: perineal urethrocervicoplasty versus classical Young-Dees procedure.
OBJECTIVE
We compared the functional results of 1-stage perineal urethrocervicoplasty and vulvoplasty vs the classic Young-Dees procedure for incontinent female epispadias.


METHODS
We treated 14 female patients with incontinent epispadias between 1997 and 2007, of whom 7 each underwent the Young-Dees procedure until 2004 (group 1) and 1-stage urethrocervicoplasty with vulvoplasty through a perineal subsymphyseal approach (group 2). We retrospectively compared patient age at surgery, bladder capacity, continence outcome and postoperative morbidity.


RESULTS
The groups were comparable except for age at procedure. In group 1 vs 2 surgery was performed at a median age of 6 vs 4 years. In groups 1 and 2 median preoperative bladder capacity was 120 and 100 cc, and mean followup was 8 and 2.5 years, respectively. Six group 1 patients achieved continence, including 5 with overnight continence, but 5 required additional surgery to enhance continence or voiding, including pericervical injections of bulking agents (3), cervicotomy or urethral calibration (4) and enterocystoplasty (1). Two patients required long-term clean intermittent catheterization, 4 underwent upper tract dilation postoperatively and 4 had a total of 8 episodes of febrile urinary tract infection. Six group 2 patients were continent, including 3 with overnight continence (p = 1). None required clean intermittent catheterization even temporarily or any additional surgery (p = 0.02). Only 2 patients had a febrile urinary tract infection (p = 0.25).


CONCLUSIONS
Reconstructing the bladder neck and urethra via a perineal approach for female epispadias is promising. Surgery may be performed earlier with similar continence results, less postoperative morbidity and less need for additional surgery. Long-term studies are needed to confirm these preliminary results.
Cheikhelard
Alaa
A
Department of Pediatric Surgery and Urology, Assistance Publique-Hôpitaux de Paris Hôpital Necker Enfants-Malades, Paris, France.
Aigrain
Yves
Y
Lottmann
Henri
H
Lortat-Jacob
Stephen
S
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004842:Epispadias / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D010502:Perineum; D012189:Retrospective Studies; D014521:Urethra / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods