THE EVOLUTION OF PENILE RECONSTRUCTION IN EPISPADIAS REPAIR - A REPORT OF 180 CASES

From 1978 to 1993, 180 boys with epispadias (85) and the exstrophy/epi spadias complex (95) underwent epispadias reconstruction at our instit ution. The 180 patients were divided into 4 groups: group 1-2-stage ep ispadias reconstruction with dissection of the corpora (30 patients), group 2-pedicled preputial tube urethroplasty either alone or with a l yophilized human dural patch to the corpora for correction of penile d eformity (35), group 3-pedicled preputial tube urethroplasty and corpo real rotation (40), and group 4-a modified Cantwell epispadias repair incorporating complete tubularized urethroplasty, cavernocavernostomy and corporeal rotation. In 46 patients from groups 1 to 3 the primary outcome was not considered satisfactory and they underwent radical pen ile revision with the modified Cantwell technique. Followup ranges fro m 1 to 15 years (mean 6 years), We conclude that a good cosmetic resul t can be achieved in almost all cases using the modified Cantwell tech nique as a primary procedure in experienced hands. This technique has a low complication rate and can be used as a salvage procedure followi ng previous unsuccessful epispadias reconstruction using other techniq ues.