The Kelly Operation for Epispadias

Abstract

PURPOSE To review the results of Kelly soft tissue reconstruction in incontinent primary epispadias. MATERIAL AND METHODS 22 patients are reviewed from our database at least 1 year after their Kelly operation. Non-invasive bladder function assessments and clinical histories were used to evaluate continence. Half (11 patients -10m, 1f) had a primary Kelly operation at a median age of 2 years (10 m - 8 y, 3 m). Half (11 patients - 9m, 2f) had a secondary Kelly procedure following previous epispadias repair, at a median age of 10 years (3 y, 3 m - 16 y). RESULTS In the Primary group 2 patients remain too young to assess reliably. Of the remainder 4/9 are dry by day and 2 of these also at night. 5/9 are judged to have no control. In the secondary group 8/11 patients are dry by day and 5 of these are also dry at night. 3 remain wet with inadequate control and capacity. All females are dry by day, 1 also at night. CONCLUSIONS As in patients with bladder exstrophy, continence relies on a combination of bladder outlet resistance and capacity. Whilst the results from secondary cases are comparable with our data in classic exstrophy (70% daytime continence) those in primary cases are inferior. Reasons for this may include: 1. patients with primary operations are younger and so their continence may continue to improve. 2. radical primary dissection may have a negative effect on native continence mechanisms in epispadias. 3. primary epispadias is not simply a more minor variant of the exstrophy-epispadias complex. (supported by anatomical observations of our cases).