Single-stage perineal urethroplasty for continence in female epispadias: a preliminary report

To evaluate the results of single-stage new technique of perineal urethroplasty with double breasting of the urethra and bladder neck and sphincteroplasty in female patients with epispadias.

We have treated 4 patients with severe female epispadias (male/female ratio 6:1) since 1991. They presented at the age of 3, 11, 12, and 23 years. Perineal urethroplasty with double breasting, sphincteroplasty, and genitoplasty was done in 3 cases. Cohen's cross-trigonal reimplantation with bladder neck reconstruction was done in the fourth patient who had an ectopic ureter, but the patient required perineal urethroplasty and genitoplasty because of partial incontinence. The urethral plate and bladder neck was mobilized from the surrounding tissue to the bladder neck. A urethral mucosal strip of about 5 to 10 mm was denuded from the bladder neck to the end of urethral plate on one lateral edge, and the urethral plate and urethral mucosa was tubularized over a 12F catheter. Urethroplasty was done with double breasting of the urethral muscle margins starting from inside the bladder neck downward to the neomeatus with corporoplasty, sphincteroplasty, and genital reconstruction.

Of the 4 patients, 3 were fully continent during the day with a dry interval of 4 to 5 hours. One of the 3 patients was partially continent and had nocturnal enuresis, which responded to anticholinergic. The fourth patient with bladder neck reconstruction was partially incontinent initially but became continent after perineal urethroplasty.

Our technique of one-stage perineal urethroplasty increases the urethral and bladder neck resistance, as well as the bladder capacity, all factors important for continence. This is a simple and effective method for the development of both continence and cosmesis in female epispadias repair.