Complete Penile Disassembly for Epispadias Repair in Postpubertal Patients

Abstract

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