922 THE RESULTS OF PENILE DISASSEMBLY FOR EPISPADIAS REPAIR IN 108 PATIENTS

Abstract

You have accessJournal of UrologyPediatrics: Reconstructive Surgery1 Apr 2010922 THE RESULTS OF PENILE DISASSEMBLY FOR EPISPADIAS REPAIR IN 108 PATIENTS Hisham Hammouda, Mohamed Elgammal, Ahmed Safwat, and Hazem Orabi Hisham HammoudaHisham Hammouda More articles by this author , Mohamed ElgammalMohamed Elgammal More articles by this author , Ahmed SafwatAhmed Safwat More articles by this author , and Hazem OrabiHazem Orabi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1713AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We evaluated the Complete penile disassembly (CPD) technique described by Mitchell and Modified penile disassembly (MPD) technique which preserves the 2 hemiglans integrity together and which was reported by Grady for Epispadias repair. METHODS A total of 108 patients with their age ranged between 3 weeks and 22 years and who had repair of Epispadias between 1998 and 2008 were included. Cases were divided into two groups; group I included 80 cases of complete Epispadias as a part of one stage closure of Bladder Exstrophy (17 of them had prior continent urinary diversion) and group II included 28 cases of complete Epispadias alone (22 primary and 6 secondary cases). Complete penile disassembly was performed in 79 (61/80 in group I &18/28 in group II) patients and MPD was performed in 29 (19/80 in group I & 10/28 in group II) patients. Urethra was closed using interrupted absorbable 6/0 or 7/0 sutures in our series, with maintaining the attachment of the urethral plate (UP) to the ventral skin (our reported modification of CPD) in 55/79 (45/61 in group I &10/18 in group II) patients and no maintaining of this attachment in 24/79 cases of CPD (16/61 in group I &8/18 in group II ) in addition to 29 cases of MPD (19/80 in group I &10/28 in group II). RESULTS Mean follow up was 48.5 months (range 12-86). Ischemic changes at glans penis was recorded in 5/79 cases which was irreversible in two cases (2.5%) during our initial experience with CPD,while this complication was not reported with MPD. Ventral orthotopic urethral meatus was achieved in all 55 cases of CPD with maintaining the attachment of the UP to the ventral skin,while it was hypospadiac in 10/24 cases of CPD (7/16 in group I & 3/8 in group II ) and 17/29 cases of MPD (11/19 in group I & 6/10 in group II) with no maintaining of UP attachment in both. Conical glans was reported in 104/108 (96.6%), straight shaft in 70/79 (85.2%) after CPD and in 26/29 (89.6%) after MPD. Urethral fistula was recorded in 4/108(3.7%) cases. Insignificant decrease for cosmetic penile length with maintaining UP attachment with ventral skin was observed. There were no reported cases of dehiscence,meatal stenosis or urethral stricture. Erectile function was preserved in all patients. CONCLUSIONS Either CPD after a considerable learning curve or MPD are safe procedures for Epispadias repair,which can provide satisfactory cosmetic and functional outcome. Keeping of UP attachment with ventral skin helps in achieving orthotopic ventral urethral meatus, however it is accompanied with insignificant decrease in cosmotic penile length. Assiut, Egypt© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e359 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hisham Hammouda More articles by this author Mohamed Elgammal More articles by this author Ahmed Safwat More articles by this author Hazem Orabi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...