Female epispadias repair: A new 1-stage technique

Purpose: Female epispadias is a rare anomaly. According to the literature i t is usually treated with staged procedures, including bladder neck reconst ruction, to achieve continence. We developed a 1-stage surgical technique t hat offers the possibility of achieving continence and a cosmetically norma l appearance of the vulva. Materials and Methods: We treated 4 patients 4 months to 8 years old. The m ain point of the technique is to free completely the urethral plate and bla dder neck from surrounding tissue. After tubularizing the urethral plate in to a urethra modified needle suspension brings the bladder neck and proxima l urethra into the intra-abdominal position. The pelvic floor is then recon structed between the anterior vaginal wall and urethra. Thus, continence ma y be attained by intra-abdominal positioning of the bladder neck and proxim al urethra as well as by pelvic floor reconstruction. Results: Of our 4 consecutive cases of primary untreated epispadias the tec hnique proved successful in 3, while followup is too short in 1. One patien t is completely dry and voids without a further procedure. Postoperatively 2 patients with 5 years or more of followup required injection of a bulking agent at the bladder neck level to achieve continence, including 1 who is damp during the day without the need to change clothes and 1 on clean inter mittent catheterization twice daily because post-void residual urine volume causes recurrent urinary tract infection. Conclusions: The described technique is promising for treating this disabli ng anomaly.