Complete penile disassembly for epispadias repair in postpubertal patients.

Abstract

OBJECTIVE:

To present the outcomes of complete penile disassembly in 14 postpubertal patients. Complete penile disassembly is widely used for epispadias repair.

METHODS:

From July 2001 to May 2008, a total of 14 postpubertal patients underwent complete penile disassembly epispadias repair. The median age at surgery was 18 years (range 14-34). Of the 14 patients, 3 patients had isolated penopubic epispadias (all with failure of previous repairs) and 11 had bladder exstrophy with no previous attempts at epispadias repair. Of the 11 patients with exstrophy, 6 had undergone previous cystectomy and rectal diversion and 5 had undergone bladder neck closure, ileocystoplasty, and creation of a continent outlet. A urethral stent was used only for patients with isolated epispadias. The first postoperative follow-up examination was at 6 weeks. Later, the patients were followed up every 3 months for 1 year.

RESULTS:

All patients had an orthotopic meatus. However, the short urethral plate was lengthened with a penile skin flap in 5 (36%) of the 14 patients to achieve an orthotopic meatus. No patient had glans/corporal ischemia. All patients had normal conical symmetric glans/corpora. Of the 3 patients undergoing redo surgery, 1 had sloughing of the distal neourethra and ended up with a coronal hypospadias. All 11 de novo patients had an orthotopic meatus with no fistula, stenosis, or dehiscence. All neourethras were easily calibrated with a 14F sound. All patients had normal straight erections with normal forward ejaculation.

CONCLUSION:

Complete penile disassembly is safe and effective surgery for epispadias repair in postpubertal patients. Lengthening of the urethral plate with a penile skin flap was required in one third of patients. The erection/ejaculatory functions were preserved in all patients.

• Authors: Ashraf T Hafez, Tamer Helmy
• Journal: Urology (Urology) Vol. 78 Issue 6 Pg. 1407-10 (Dec 2011) ISSN: 1527-9995 [Electronic] United States
• PMID: 21924761 (Publication Type: Journal Article)
• Copyright: Copyright © 2011 Elsevier Inc. All rights reserved.

Topics

• Abnormalities, Multiple
• Adolescent
• Adult
• Bladder Exstrophy
• Ejaculation
• Epispadias (surgery)
• Humans
• Male
• Penile Erection
• Penis (physiology, surgery)
• Reoperation
• Sexual Behavior (psychology)
• Treatment Outcome
• Urethra (surgery)
• Young Adult