MP25-02 PENILE DISASSEMBLY IN EXSTROPHY: TIME TO REEVALUATE?

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) II1 Apr 2018MP25-02 PENILE DISASSEMBLY IN EXSTROPHY: TIME TO REEVALUATE? Matthew Kasprenski, Mahir Maruf, John Jayman, Karl Benz, Jason Michaud, Emily Dunn, and John Gearhart Matthew KasprenskiMatthew Kasprenski More articles by this author , Mahir MarufMahir Maruf More articles by this author , John JaymanJohn Jayman More articles by this author , Karl BenzKarl Benz More articles by this author , Jason MichaudJason Michaud More articles by this author , Emily DunnEmily Dunn More articles by this author , and John GearhartJohn Gearhart More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.839AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Epispadias repair, using the complete penile disassembly technique, is frequently combined with primary bladder closure in patients with classic bladder exstrophy (CBE). Yet, penile disassembly has been posited as a risk for penile injury by ischemic mechanisms. Herein, the authors present all CBE cases referred to their institution where primary closure with penile disassembly epispadias repair was complicated by penile injury. METHODS A prospectively-maintained institutional database of 1311 exstrophy-epispadias complex patients was reviewed for complete primary repair of CBE cases referred to the authors' institution, and those with injury to the penis were identified. The location, extent of injury, and subsequent management is reported. Triplanar magnetic resonance imaging (MRI) of the pelvis with volumetric analysis was used for penile compartment quantification. RESULTS Of the 170 CBE patients referred after a prior complete primary repair, 22 (13%) were identified with penile loss. A majority (82%) were closed in the neonatal period, and 55% had a pelvic osteotomy. Eight patients (38%) had a failed primary closure. Median follow-up time was 10 years (range 3-21). Penile injury was often unilateral (82%), and involved the glans and/or corpora cavernosa. MRI of the pelvis confirmed anterior corporal deficiency that resulted from primary closure. Three patients were successfully managed with myocutaneous neophalloplasty between the ages of 15 and 16 years old. CONCLUSIONS As a part of the primary bladder closure, penile disassembly for epispadias repair may lead to penile ischemia. In addition to reconstructive planning, MRI may be used to quantify penile injury. CBE patients with penile injury can be managed with myocutaneous phalloplasty. Because of the soft tissue loss with complete penile disassembly, it may be time to reevaluate the application of this technique in the reconstruction of bladder exstrophy. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e326 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Matthew Kasprenski More articles by this author Mahir Maruf More articles by this author John Jayman More articles by this author Karl Benz More articles by this author Jason Michaud More articles by this author Emily Dunn More articles by this author John Gearhart More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...