Complete Penile Disassembly (CPD) for Epispadias Repair in Postpubertal Patients

Abstract

Purpose CPD is widely utilized for epispadias repair. Herein, the outcome of such technique in 14 post pubertal patients is presented. Material and Methods Between July 2001 and May 2008, a total of 14 post pubertal patients underwent CPD epispadias repair. Mean age at surgery was 18.9 years (range 14-34). Eleven patients were born with bladder exstrophy. Six patients had previous cystectomy and rectal diversion with no epispadias repair. The remaining 5/11 exstrophy patients had bladder neck closure, ileocystoplasty and continent outlet. The remaining 3/14 patients had isolated penopubic epispadias and all underwent previous failed epispadias repairs. Urethral stent was used for patients with isolated epispadias. The first postoperative follow-up was at 6 weeks. Later patients were followed every 3 months for one year. Results All patients had an orthotopic meatus intra-operatively. However, the short urethral plate was augmented with a penile skin flap in 5/14(36%) patients. No patient had glans/corporal ischemia. All patients had normal conical symmetrical glans/corpora. One, redo, patient had sloughing of the distal neourethra and ended up with a coronal hypospadias. All the remaining 13/14 (93%) patients had orthotopic meatus with no fistula, stenosis, or dehiscence. All neourethras were easily calibrated with 14F sound. All patients had normal straight erections with normal forward ejaculation. Conclusions CPD is safe and effective for epispadias repair in post pubertal patients. Augmentation of the urethral plate with a penile skin flap is required in one third of patients. With careful dissection, the erection/ejaculatory functions are preserved in all patients.