Ashraf T Hafez1, Tamer Helmy. 1. Urology and Nephrology Center, Mansoura University Faculty of Medicine, Mansoura, Egypt. athafez@yahoo.com
Abstract
OBJECTIVE: To present the outcomes of complete penile disassembly in 14 postpubertal patients. Complete penile disassembly is widely used for epispadias repair. METHODS: From July 2001 to May 2008, a total of 14 postpubertal patients underwent complete penile disassembly epispadias repair. The median age at surgery was 18 years (range 14-34). Of the 14 patients, 3 patients had isolated penopubic epispadias (all with failure of previous repairs) and 11 had bladder exstrophy with no previous attempts at epispadias repair. Of the 11 patients with exstrophy, 6 had undergone previous cystectomy and rectal diversion and 5 had undergone bladder neck closure, ileocystoplasty, and creation of a continent outlet. A urethral stent was used only for patients with isolated epispadias. The first postoperative follow-up examination was at 6 weeks. Later, the patients were followed up every 3 months for 1 year. RESULTS: All patients had an orthotopic meatus. However, the short urethral plate was lengthened with a penile skin flap in 5 (36%) of the 14 patients to achieve an orthotopic meatus. No patient had glans/corporal ischemia. All patients had normal conical symmetric glans/corpora. Of the 3 patients undergoing redo surgery, 1 had sloughing of the distal neourethra and ended up with a coronal hypospadias. All 11 de novo patients had an orthotopic meatus with no fistula, stenosis, or dehiscence. All neourethras were easily calibrated with a 14F sound. All patients had normal straight erections with normal forward ejaculation. CONCLUSION: Complete penile disassembly is safe and effective surgery for epispadias repair in postpubertal patients. Lengthening of the urethral plate with a penile skin flap was required in one third of patients. The erection/ejaculatory functions were preserved in all patients.
OBJECTIVE: To present the outcomes of complete penile disassembly in 14 postpubertal patients. Complete penile disassembly is widely used for epispadias repair. METHODS: From July 2001 to May 2008, a total of 14 postpubertal patients underwent complete penile disassembly epispadias repair. The median age at surgery was 18 years (range 14-34). Of the 14 patients, 3 patients had isolated penopubic epispadias (all with failure of previous repairs) and 11 had bladder exstrophy with no previous attempts at epispadias repair. Of the 11 patients with exstrophy, 6 had undergone previous cystectomy and rectal diversion and 5 had undergone bladder neck closure, ileocystoplasty, and creation of a continent outlet. A urethral stent was used only for patients with isolated epispadias. The first postoperative follow-up examination was at 6 weeks. Later, the patients were followed up every 3 months for 1 year. RESULTS: All patients had an orthotopic meatus. However, the short urethral plate was lengthened with a penile skin flap in 5 (36%) of the 14 patients to achieve an orthotopic meatus. No patient had glans/corporal ischemia. All patients had normal conical symmetric glans/corpora. Of the 3 patients undergoing redo surgery, 1 had sloughing of the distal neourethra and ended up with a coronal hypospadias. All 11 de novo patients had an orthotopic meatus with no fistula, stenosis, or dehiscence. All neourethras were easily calibrated with a 14F sound. All patients had normal straight erections with normal forward ejaculation. CONCLUSION: Complete penile disassembly is safe and effective surgery for epispadias repair in postpubertal patients. Lengthening of the urethral plate with a penile skin flap was required in one third of patients. The erection/ejaculatory functions were preserved in all patients.