title: Penile repair in patients with epispadias-exstrophy complex-can we prevent resultant hypospadias?
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Division of Pediatric Urology, Department of Nephrology and Urology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. paolo.caione@opbg.net
authors.forename: Paolo
authors.initials: P
authors.lastname: Caione
authors.forename: Simona Gerocarni
authors.initials: SG
authors.lastname: Nappo
authors.forename: Ennio
authors.initials: E
authors.lastname: Matarazzo
authors.forename: Ivan Pietro
authors.initials: IP
authors.lastname: Aloi
authors.forename: Alberto
authors.initials: A
authors.lastname: Lais
mesh_terms: D001746:Bladder Exstrophy / Q000150:complications / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004842:Epispadias / Q000209:etiology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007021:Hypospadias / Q000209:etiology / Q000517:prevention & control*; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods*