title: Long-term follow-up after traditional versus modified perineal approach in the management of female epispadias.
abstract: OBJECTIVE
  Isolated female epispadias (IFE) is a rare congenital anomaly. The defect extends to the bladder neck, which is usually incompetent. The traditional surgical approach includes urethral and genital reconstruction in the first year, followed by bladder neck reconstruction (Young-Dees-Leadbetter cervicoplasty (YDL)) at the age of social continence. An alternative single-stage technique includes urethral, bladder neck and clitoris repair by a perineal approach. The aim of the present study was to describe long-term follow-up of patients who underwent the traditional vs alternative approach.
  
  
  METHODS
  A retrospective review was performed of all female epispadias cases managed between 2000 and 2013. The YDL procedure (Group 1) vs single-stage perineal approach (Group 2) cases were followed and compared. Collected variables included: patients' demographics, age at diagnosis and surgery, presence of associated anomalies, clinical presentation, presence of vesicoureteral reflux (VUR), and pre-operative and postoperative continence.
  
  
  RESULTS
  A total of 12 cases of female epispadias were managed and followed between 2000 and 2013. No major complications occurred in either group. Urinary continence evaluated in seven children showed that none (0/3) and 4/7 (57%) were continent following the initial procedure in Group 1 and Group 2, respectively. All patients in Group 1 failed to achieve continence and required re-intervention.
  
  
  CONCLUSIONS
  Female epispadias could be successfully repaired using a single-stage modified perineal approach that achieved good continence with volitional voiding, good cosmetic results and compared favorably with the ones repaired with the YDL technique. The additional step of performing bladder neck tailoring to achieve a funneling configuration seemed to be useful in improving continence.
authors.affiliation: Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada; Urology Division, Department of Surgery, King Saud University, King Saud University Medical City and College of Medicine, Riyadh, Saudi Arabia.
authors.forename: F
authors.initials: F
authors.lastname: Alyami
authors.affiliation: Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
authors.forename: N
authors.initials: N
authors.lastname: Fernandez
authors.affiliation: Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Lee
authors.affiliation: Division of Pediatric Urology, Department of Pediatric Surgery, University of Alberta, Mackenzie Health Sciences Centre, Edmonton, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Metcalfe
authors.affiliation: Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Lorenzo
authors.affiliation: Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Division of Urology, Sidra Medical and Research Center, Doha, Qatar. Electronic address: psalle@sidra.org.
authors.forename: J
authors.initials: J
authors.lastname: Pippi Salle
mesh_terms: D000293:Adolescent; D002170:Canada; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004842:Epispadias / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010502:Perineum / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000175:diagnosis / Q000453:epidemiology; D014554:Urination / Q000502:physiology; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*
keywords: Bladder neck reconstruction; Epispadias; Incontinence