V7-04 MULTI-INSTITUTIONAL BLADDER EXSTROPHY CONSORTIUM: TECHNICAL STANDARDIZATION OF DISTAL EPISPADIAS REPAIR IN A BOY

Abstract

You have accessJournal of UrologyPediatrics1 Apr 2016V7-04 MULTI-INSTITUTIONAL BLADDER EXSTROPHY CONSORTIUM: TECHNICAL STANDARDIZATION OF DISTAL EPISPADIAS REPAIR IN A BOY John Ward, David Chu, Jason Van Batavia, Aseem Shukla, Dana Weiss, Joseph Borer, Evalynn Vasquez, John Kryger, Travis Groth, Michael Mitchell, and Douglas Canning John WardJohn Ward More articles by this author , David ChuDavid Chu More articles by this author , Jason Van BataviaJason Van Batavia More articles by this author , Aseem ShuklaAseem Shukla More articles by this author , Dana WeissDana Weiss More articles by this author , Joseph BorerJoseph Borer More articles by this author , Evalynn VasquezEvalynn Vasquez More articles by this author , John KrygerJohn Kryger More articles by this author , Travis GrothTravis Groth More articles by this author , Michael MitchellMichael Mitchell More articles by this author , and Douglas CanningDouglas Canning More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.561AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Distal male epispadias is a relatively rare entity in the spectrum of exstrophy-epispadias complex. We present a video of a recent distal male epispadias repair that includes skin closure with a rotational skin flap as described by Salle. Preoperative videourodynamics had demonstrated a marginally continent bladder neck, but otherwise normal bladder function. METHODS Technique was male epispadias repair without osteotomy performed at 9 months of life. No pelvic diastasis was present. High-definition video recording was used for real-time local and remote observation and future teaching, analysis, and review as part of the Multi-Institutional Bladder Exstrophy Consortium (MIBEC). RESULTS Our video demonstrates the repair of a mid-shaft distal male epispadias. The penis was initially degloved with a dorsal incision that circumscribes the urethral plate. The corpus spongiosum was then carefully separated off the corpora cavernosal bodies ventrally before moving dorsally. The proximal extent of dissection was the penopubic junction. The corpus spongiosum with dorsal urethral plate was isolated on a vessel loop. Distally, glans wings were made. The glans was never completely disassembled from the corpora cavernosal bodies. A urethroplasty was performed over an 8F urethral stent, and then replaced with a 6F stent that was sutured in place. Next, the neo-urethra and neo-meatus were advanced distally and the urethral plate situated more ventrally. Glansplasty was performed followed by reapproximation of corpora cavernosal bodies dorsally over the urethra without significant medial rotation. Finally, a ventral transverse island penile shaft skin flap was rotated 270 degrees counterclockwise around the penis using the technique of Salle to form a lateral-lying suture line. Three months later the meatus appeared orthotopic and the repair had healed well, with the exception of a small noticeable scar at the location of the suture line of the Salle skin flap (Figure 1). CONCLUSIONS Distal male epispadias repair can be performed effectively in the setting of MIBEC. High-quality video recording of such rare repairs can aid in future teaching and review. The Salle skin closure offers promise to avoid a dorsal penile shaft scar but requires long-term outcomes. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e723 Advertisement Copyright & Permissions© 2016MetricsAuthor Information John Ward More articles by this author David Chu More articles by this author Jason Van Batavia More articles by this author Aseem Shukla More articles by this author Dana Weiss More articles by this author Joseph Borer More articles by this author Evalynn Vasquez More articles by this author John Kryger More articles by this author Travis Groth More articles by this author Michael Mitchell More articles by this author Douglas Canning More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...