The genital aspects of exstrophy.

Area of Science:

• Urology
• Pediatric Surgery
• Developmental Biology

Background:

• Exstrophic deformities, particularly cloacal exstrophy, are associated with significant genital anomalies.
• The severity of genital defects correlates with the primitiveness of the exstrophy.
• Male epispadias, with or without bladder exstrophy, presents a primary surgical challenge.

Purpose of the Study:

• To describe the etiology of genital anomalies in exstrophic deformities.
• To outline surgical techniques for correcting penile deformities in affected male patients.
• To emphasize the importance of early and maximal surgical reconstruction.

Main Methods:

• Review of the embryological basis of exstrophic deformities and associated genital anomalies.
• Description of surgical principles for penile reconstruction, including chordee release and phallic lengthening.
• Discussion of the goals of surgical intervention in pediatric patients.

Main Results:

• Genital tract anomalies are invariable with cloacal exstrophy.
• Penile reconstruction involves freeing the urethra and lengthening the phallus.
• Early surgical correction is crucial for optimal outcomes.

Conclusions:

• The wedge effect of the cloacal membrane is the primary cause of genital anomalies in exstrophy.
• Surgical correction of penile deformities in male epispadias aims to provide an adequate phallus.
• Maximal correction of these congenital anomalies should be pursued at an early age.