We describe the complications of complete repair and their management.
MATERIALS AND METHODS: A total of 19 patients were referred after failed complete repair. Total dehiscence occurred in 6 males, major bladder
prolapse in 3, minor
prolapse in 3, pubic separation in 1, impassable
stricture in 1, and total hemiglans and corporal loss in 2. Overall, partial glans loss was seen in 7 patients, urethral loss in 5 and penile skin loss in 3. One female had complete dehiscence and 1 had major
prolapse, both losing the urethrovaginal septum. One female had an impassable
stricture.
RESULTS: Six males with dehiscence underwent re-closure with
osteotomy. Urethral replacement was performed with full thickness skin graft (FTSG) in 3 and with buccal mucosa in 3. Five patients underwent a modified Cantwell-Ransley (C-R)
epispadias repair after placement of skin expanders, and 1 awaits repair. The 3 patients with major
prolapse underwent re-closure with
osteotomy. A urethral buccal graft was used in 1 patient, FTSG was used in 2 at a later operation and all 3 underwent C-R
epispadias repair. Of the 3 patients with minor
prolapse 2 underwent re-closure with
osteotomy using urethral buccal graft or FTSG followed later with a C-R repair. The final patient with minor
prolapse underwent re-closure with
osteotomy and C-R repair after
testosterone stimulation. One patient with pubic separation and urethral and skin loss underwent re-closure with
osteotomy, C-R repair after skin expanders and later bladder neck repair. In 1 case a ureteral graft replaced a
posterior urethral stricture. Of the 2 patients with hemiglans and corporal loss 1 underwent penile torsion repair and later
hypospadias repair, while the other is being observed. Two females underwent re-closure with
osteotomy and urethral replacement with tubularized bladder. The case of
stricture was managed endoscopically.
CONCLUSIONS: Complications of complete repair are similar to those of other repairs but more serious if soft tissue loss occurs. Because of these increased risks, this procedure and its formidable complications are best managed by experienced exstrophy surgeons.