M.DjordjevicV.KojovicM.BizicMajstorovicEpispadias Repair after Failed Surgery in ChildhoodEur J Pediatr Surg2012[EPUB

Abstract

Redo surgery in failed epispadias presents a great challenge. The authors present a radical approach for correction of penile deformities as well as urethral reconstruction in patients after failed epispadias repair. Between January 2006 and January 2011, 13 patients, aged 13 to 22 years, underwent redo surgery owing to failed epispadias repair in childhood. All patients presented with severe dorsal curvature and short urethra. A first operation included penile disassembly with complete separation of corporal bodies, urethral dissection, and transposition and subtotal glans mobilization. The residual dorsal curvature was corrected by tunical incision and grafting of the defect. The short urethra was dissected and transposed ventrally with opening at the base of the penis. Penile entities were reassembled in normal anatomical relationship, and the penile body was covered using available vascularized skin flaps. In a second step, after 6 months, the reconstruction of the penile urethra using buccal mucosa graft and scrotal hairless skin flap was performed. After a mean follow-up of 33 months, acceptable outcome was achieved in all the patients. Complete penile lengthening and straightening were obtained in 10 out of 13 patients. Mild curvature was noted in three patients without consequences. Satisfactory sexual activity was reported in nine patients. One patient developed a fistula that was closed after 4 months. All other patients reported normal voiding with no difficulties. The authors conclude that a radical approach is necessary in redo surgery in failed epispadias repairs to achieve a complete repair of all penile deformities with satisfactory postoperative outcome.