THE CANTWELL-RANSLEY EPISPADIAS REPAIR IN EXSTROPHY AND EPISPADIAS - LESSONS LEARNED

Objectives. We evaluated our experience with the Cantwell-Ransley epis padias repair to determine the lessons that have been learned with the increased experience and follow-up, Methods. A total of 75 boys (60 w ith bladder exstrophy and 15 with complete epispadias) underwent a Can twell-Ransley epispadias repair at our institute in the last 6 years. Primary repair was performed in 58 boys (45 with exstrophy and 13 with epispadias), and secondary repair was performed after prior failed cl osure in 17 boys (12 at the secondary exstrophy closure, 3 with exstro phy, and 2 with complete epispadias). Results, At a mean follow-up of 28 months, all patients had a horizontal or downward angled penis whil e standing. The incidence of urethrocutaneous fistulas in the immediat e postoperative state was 21% and at 3 months was 15%. The incidence o f urethrocutaneous fistulas was no more in those patients in whom para exstrophy skin flaps were used at anterior closure than in those in wh om the urethral plate was left intact. Two patients developed a urethr al stricture at the proximal anastomotic area, and 4 patients had mino r skin separation of the dorsal penile skin closure. Catheterization o r cystoscopy, or both, has been performed in 60 patients and revealed an easily negotiable urethral channel in all. Conclusions. The Cantwel l-Ransley epispadias repair offers a straighter urethra, better correc tion of chordee and cosmesis, and a lower fistula rate in the exstroph y or epispadias patient.