Evolution of male epispadias repair: 16-year experience

Purpose: We review our experience during the last 16 years, adopting differ ent surgical approaches for epispadias repair, and compare the results of c omplete penile disassembly technique with perineal muscular complex reassem bly since 1995 with previous repairs. Materials and Methods: From 1984 to 1999, 58 epispadias repairs were perfor med in 53 male patients 3 days to 13 years old, including 18 with primary p enopubic epispadias, 35 with bladder exstrophy and 5 treated with secondary genito-urethroplasty after previous repairs of the exstrophic complex. Cas es were divided into 2 periods of the surgical procedure. Different techniq ues succeeded in 41 patients in the first decade (group 1) while the comple te penile disassembly with perineal muscular complex reassembly technique w as used in 17 patients during the last 5-year period (group 2). Results of both groups were compared, and Fisher's exact test was used for statistical analysis. Results: Of the 41 group 1 cases complications (mostly fistula and/or ureth ral stenosis) in 21 (51%) required 1 or multiple operations. Continence was never achieved with urethroplasty alone. Cosmetic appearance of the phallu s was not satisfactory in 23 cases (29%) and urethral catheterization was d ifficult in 8 (19%). Of the 17 group 2 cases only 2 complications (110%) oc curred (1 fistula and 1 distal urethral stenosis). Dry intervals or volunta ry continence was achieved in 6 of the 10 patients with exstrophy and in al l but 1 with epispadias without bladder neck surgery. The penis had a satis factory cosmetic appearance and no dorsal chordee with an easily catheteriz able urethra was noted. The complication rate was significantly different i n the 2 groups (Fisher's exact test p = 0.0042). Conclusions: The complete penile disassembly with perineal muscular complex reassembly technique, with deeper positioning of the urethra in the perine al musculature, seems to guarantee a significant step forward in functional epispadias repair.