Original Insights Into Surgical Anatomy and Histology of Corporal Bodies of the Epispadiac Penis with Implications for Surgery

Abstract

PURPOSE Surgical anatomy and histology of corporal bodies of the epispadiac penis is still not well described. Using our complete disassembly technique we revealed specific anatomical and histological features of the epispadiac penis which have a significant impact on surgical outcome. MATERIAL AND METHODS From October 1996 till August 2007, 58 patients age between 2 days and 23 years (mean 48 months) underwent primary repair of the epispadiac penis. Nineteen patients presented with an isolated epispadias while the remaning 39 had epispadias –extrophy complex. Complete penile disassembly with mobilization of NVB, urethral plate and corporal bodies was performed. Free corporeal bodies are evaluated during surgery in the flaccid and erect state. In 8 patients a histological specimen was harvested from ventral, medial and wedge-shaped dorsal side. RESULTS Investigating anatomical and histological features of the epispadiac penis we revealed several important particularities. Corporal bodies have a triangular shape: ventral - convex side, medial and lateral. Dorsal side is concave and narrowed into a wedge shaped streak. The main substrate of dorsal curvature is disproportion between longer ventral and shorter dorsal side. Histological examination revealed a normal ventral side of albuginea with two layers while medial side have only an underdeveloped circular layer. Dorsal, wedge-shaped side consists only of thick fibrous tissue. These features are compared to normal peers’ cavernosal bodies. CONCLUSIONS A new insight into anatomical and histological features of epispadiac corporal bodies have significant impact on surgical repair. Only equalizing the shorter dorsal and longer ventral side by minimum of two transversal dorsal incisions with grafting can correct curvature and this way straighten and lengthen the penis.