Single-stage bladder neck plication via a perineal approach for female epispadias

Abstract

Objective To evaluate urinary continence and cosmetic result of female epispadias managed by single-stage bladder neck plication via a perineal approach.Methods The clinical data of 3 female epispadias patients hospitalized with complete incontinence in April 2008,November 2009 and February 2012 respectively were reviewed.Their presentation ages were 37,44 and 51 months.Wide-open bladder neck and short urethra were observed under cystoscopy.And the distances between meatus and bladder neck were 1.8,2.3 and 1.5 cm respectively.Preoperatively,grade 3 urinary incontinence was evaluated with the scoring system recommend by the International Children's Continence Society.Repairing epispadias and formalizing external genitalia of 3 cases were managed with single-stage bladder neck plication via a perineal approach.Bladder neck reconstruction of a third case was guided by cystoscopy.Results Postoperatively 2 girls presented with intermittent bladder spasm and released with anticholinergic drug.No urinary retention was observed.Good urinary continence of grade 0 (n =2) and grade 1 (n =1) was achieved at months 13,16 and year 2 respectively.No urinary infection occurred.The parents found that voiding time of their children was longer than that of preoperation and external genitalias achieved satisfactory cosmetic appearances.Conclusions Good urinary continence and cosmetic appearance of external genitalia may be achieved with single-stage bladder neck plication for female epispadias via a perineal approach.Outlet resistance of bladder neck and urethra during bladder neck plication are manageable under cystoscopic guidance. Key words: Epispadias; Urinary incontinence; Urological surgical procedures