Functional and cosmetic outcome of partial penile disassembly repair in isolated male epispadias patients

Introduction

Epispadias is a rare congenital anomaly and requires a carefully constructed and well-planned approach for the management. Modified Cantwell-Ransley technique and Mitchell's complete penile disassembly are commonly used technique and these may require multiple surgeries in majority of the patients to achieve the goals of cosmesis and continence.

Objective

To evaluate the functional and cosmetic outcome of single stage partial penile disassembly repair in isolated male epispadias.

Patients and methods

A retrospective analysis of 43 cases of primary epispadias repair, performed during July 1998 to March 2013. Patients were classified on the basis of type of epispadias, urinary incontinence, presence/degree of chordee and penile rotation.

Technique

Penile de-gloving with mobilization of urethral plate from ventral to dorsal aspect with preservation of blood supply at both ends, distally up to the level of mid-glans and proximally up to pubic symphysis with division of peno-pubic ligament to lengthen the penis and position the urethra ventrally. Tubularization of urethral plate followed by spongioplasty, corporoplasty with medial rotation of corporeal bodies (without any corporotomy) and glanuloplasty with meatoplasty is done to bring the meatus ventrally. Skin cover with rotation of ventral flaps and z-plasty when required.

Results

Age of the patients varied from 6 months to 26 years with a mean of 9 years. Ninety three percent of the patients had excellent cosmetic outcome while seven percent had minimal residual chordee/torque but did not require any surgery. None of the patients developed complications like fistula or stricture. All the 12 patients in the postpubertal group reported normal erections and successful ejaculations after the surgery. Postoperative follow up ranged from 2 to 10 years with a mean of 4 years.

Conclusions

The technique incorporates all the benefits of Cantwell-Ransley repair, can be done with less extensive dissection than total penile disassembly. Both functional and cosmetic results are good with low complication rate. Spongioplasty reconstructs near normal urethra and corporoplasty with spongioplasty also helps in prevention of urethral fistula.