COMPLETE MALE EPISPADIAS - GENITAL RECONSTRUCTION AND ACHIEVING CONTINENCE

We report on 15 patients who were primarily treated for complete male epispadias at our institution since 1975. Repair of epispadias was per formed using a modified Young urethroplasty in 13 patients and a Cantw ell-Ransley urethroplasty in 2. In addition, 2 patients underwent a Ca ntwell-Ransley urethroplasty with chordee repair after a previous Youn g urethroplasty failed. Bladder capacity increased from a mean of 50 c c before repair to 92 cc after urethroplasty. A urethrocutaneous fistu la developed in 6 cases, including 5 Young repairs and 1 Cantwell-Rans ley. Three fistulas resolved spontaneously and there were no urethral strictures. Bladder neck reconstruction was performed in 11 patients. Time to initial continence ranged from 21 days to 6 months (mean 3 mon ths) postoperatively. All patients attained daytime continence in a me an of 9 months (range 21 days to 24 months) after bladder neck reconst ruction, including 9 of 11 (82%) who achieved total day and night cont inence. Mean followup was 7 years (range 1 to 10). Modern treatment of complete male epispadias allows for an excellent genital appearance a nd achievement of urinary continence.