Male epispadias repair: Surgical and functional results with the Cantwell-Ransley procedure in 40 patients

Purpose: We present our experience using the Cantwell-Ransley epispadias te chnique, particularly focusing on postoperative anatomical and functional c omplications. Materials and Methods: Between 1989 and 1997, 40 patients 1 to 28 years old underwent the Cantwell-Ransley technique for epispadias at our institution . The condition was isolated in 17 cases and associated with exstrophy in 2 3. Surgery involved a primary and secondary procedure in 29 and 11 patients , respectively. Cavernocavernostomy was performed in only 16 cases. Results: At a mean followup of 3 years 18 patients (45%) had complications and needed further procedures, and 3 (7.5%) had major wound dehiscence. The complication rate was higher in the exstrophy than in the isolated epispad ias group (65 versus 28%) and urethral complications were consistently asso ciated with previous urethral plate sectioning. In 1 patient major and pers istent loss of continence was probably related to prolonged transurethral b ladder drainage. All 17 patients in the postpubertal group report erections , although 1 who did not undergo cavernocavernostomy still complains of dor sal curvature. In 36 patients (90%) a fully satisfactory anatomical and fun ctional result was achieved. Conclusions: The Cantwell-Ransley technique of epispadias repair allows suc cessful reconstruction in most patients. However, postoperative complicatio ns, some of which are serious, may develop that are more associated with pr evious procedures that compromise the blood supply to the urethral plate th an the Cantwell-Ransley technique.