Modified Cantwell-Ransley for the primary and secondary repairs in 31 isolated male epispadias

Abstract

To evaluate the efficacy of the modified Cantwell Ransley for primary and secondary repairs in isolated male epispadias. A retrospective analysis including 24 primary and 7 secondary cases of male epispadias from December 2015 was performed. Primary repair was performed in 24 cases (glanular in 6, penile shaft in 7 and penopubic in 11). The means age was 21 months-old. VUR was detected in 3/24 cases. No boys reported complete incontinence. Secondary salvage repair was carried on in 7 cases. The mean age was 10.7 years-old. 1 case had penile dorsal curvature, 4 cases had urinary fistula and 2 cases had both. They did not have VUR. Two patients over the age of 10 had stress urinary incontinence. All patients underwent modified Cantwell-Ransley. There were no complications of wound infection, glanular or corpus ischemic necrosis. Two primary cases had a temporary urinary leakage after operation. Patients of the primary repair were followed up for an average of 20 months. The Qmax was 11.9 ml/s after half year. Two cases showed penile torsion. No obvious urinary incontinence or recurrence of penile curvature was noted. However, most of the penile appeared to be buried. Patients of the secondary repair were followed up for 2 years. The Qmax was 17.8 ml/s after half year. Two cases of stress urinary incontinence did not significantly improve the continence. The penis was clearly visible. There was no recurrence of penile curvature or urinary fistula. The modified Cantwell-Ransley manoeuvre can be applied for both primary and most of the secondary salvage repairs for male epispadias. However, the penis looked concealed in most of little boy but can be obviously visible in the adolescents. The effect on the improvement of urinary incontinence is limited.