MD University Children's Hospital, Faculty of Medicine, University of Belgrade
Introduction: Epispadias is one of the rarest birth defects that characterizes the failure of the urethral tube to tubularize on the dorsal aspect. It can be associated with bladder exstrophy, or isolated. There are different techniques for the epispadias repair, but still, there is a high incidence of failure and need for reoperation. We present the outcomes of pediatric and adult patients in whom epispadias repair was performed in our Center.
Methods: Between March 2005 and September 2020 we surgically treated 36 patients for epispadias that were divided into 2 groups according to the type of repair – primary (group I) or secondary (group II). Group I included 19 patients with the mean age of 23 month and 17 patients with the mean age of 19 years. In patients from the group I, the surgical approach was as a one-stage procedure using complete penile disassembly technique, while in Group II surgery was done as a two-stage procedure and included complete straightening and lengthening of the penis, followed by urethral reconstruction. In Group I urethral plate was mobilized, transposed ventrally, tubularized and augmented with vascularized preputial skin flap where needed. In Group II penile straightening and lengthening was achieved by tunica albuginea incision and grafting, while in the second stage urethroplasty was performed either using the buccal mucosa graft and genital skin flaps or with tubularization of genital skin flaps. Successful treatment was defined as a functional and esthetically acceptable penis without complications.
Results: The mean follow-up was 91 months. Satisfactory results were achieved in 26/36 patients. Urethral fistula occurred in 6/19 patients from Group I and in 4/17 patients in Group II and was surgically repaired after. Skin dehiscence occurred in 10 patients, 4 from Group I and 6 from Group II, respectively. Recurrent penile curvature was observed in 3/19 patients from Group I and required surgical correction and in 2/17 patients from Group II and was mild, without the need for surgical repair. Eleven patients from Group II who filled International Index for Erectile Function (IIEF), reported satisfying erectile function, sexual desire, intercourse and overall satisfaction.
Conclusions: Primary or RE-DO epispadias repair is challenging even for experienced reconstructive urologists. Only radical surgical approach can lead to complete correction of all deformities and provide successful outcome.