title: Modified penile disassembly technique for boys with epispadias and those undergoing complete primary repair of exstrophy: long-term outcomes.
abstract: OBJECTIVE
  To describe our experience performing the modified penile disassembly technique for boys with epispadias and for those undergoing complete primary repair of exstrophy.
  
  
  METHODS
  Between January 2004 and July 2009, 34 boys underwent the modified penile disassembly technique at our institution. The first group included 15 boys with bladder exstrophy who underwent complete primary repair of exstrophy. The second group comprised 11 boys with penopupic epispadias after previous closure of bladder exstrophy. The third group included 8 boys with isolated complete epispadias.
  
  
  RESULTS
  The age range was 3 months to 8 years (median, 9 months). The follow-up time ranged from 36 months to 8 years (mean, 63 months). A conical-shaped glans with the absence of any ischemic changes occurred in 94% of patients. A mild degree of penile dorsal tilt occurred in 11.7% of patients, urethrocutanous fistula in 17.6% and meatal stenosis 5.8%. In cases of complete primary repair of exstrophy, hydronephrosis occurred in 66.6% of patients. Vesicoureteral reflux appeared in 60% of patients; despite suppressive antibiotic therapy, 33.3% are awaiting reimplantation. Continence with volitional voiding with dry intervals of ≥3 h was achieved in 40% of patients.
  
  
  CONCLUSIONS
  The modified penile disassembly technique can be used in epispadias and complete primary repair of exstrophy with excellent cosmetic results. Preservation of the distal urethral plate along with both hemiglans avoids shortening and prevents occurrence of hypospadias. Complete primary repair of exstrophy is a feasible technique with positive effects on continence with preservation of kidney function.
authors.affiliation: Department of Urology, Faculty of Medicine, El-Minia University, El-Minia, Egypt.
authors.forename: Ahmed Zaki Mohamed
authors.initials: AZ
authors.lastname: Anwar
authors.forename: Mamdouh Abdel-Hamid
authors.initials: MA
authors.lastname: Mohamed
authors.forename: Alayman
authors.initials: A
authors.lastname: Hussein
authors.forename: Alaa Mohammed
authors.initials: AM
authors.lastname: Shaaban
mesh_terms: D001746:Bladder Exstrophy / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004842:Epispadias / Q000601:surgery*; D006801:Humans; D008297:Male; D010413:Penis / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000379:methods
keywords: bladder exstrophy; continence; epispadias; penile; urologic surgical procedures