Penile disassembly technique for epispadias repair: Variants of technique

Purpose: We present 2 variants of the penile disassembly technique for epis padias repair that refine some details of the Mitchell technique. In some c ases the urethral plate retracts and shortens, and there may be poor vascul arization at the most distal portion. In addition, when the neurovascular b undles of the separated hemicorporeal glanular bodies are intact, it is dif ficult to achieve excellent correction of dorsal chordee. Materials and Methods: Between 1995 and 1998 we performed the modified Mitc hell technique in 11 boys 2 to 14 years old using 1 of 2 variants. For vari ant 1 the hemiglans and urethral plate remain connected by a small tissue b ridge to avoid shortening the urethral plate and ensure a better blood supp ly. For variant 2 each corporeal body is dissected from the glans cap and n eurovascular bundle to achieve complete mobility. This procedure enables id eal mobility of the corporeal bodies as well as curvature repair. When corp oreal rotation was unsuccessful, we corrected persistent dorsal chordee usi ng the Ransley corporotomy with corporostomy in 2 patients and with dermal grafting in 1. Results: Mean followup was 17 months (range 6 to 30). Dorsal curvature was corrected in all cases. Cosmetic appearance was good. Complications include d meatal stenosis and urethral fistula in 1 case each. Conclusions: Our variants of epispadias repair may be good alternatives to the Ransley and Mitchell complete penile disassembly techniques.