Reconstruction of the epispadiac penis in adolescents

Now that reconstructive surgery has taken the exstrophy and epispadias patient beyond the stage of merely saving life and even preserving bladder function, it is essential that proper attention is paid to the penis. Careful surgery in early life may well give a good cosmetic appearance during the important years of schooling. It may also produce a penis with a satisfactory angle of erection for sexual intercourse. In those patients who are not so fortunate in infancy or who were born before the era of modern reconstructive surgery, careful assessment must be made at an appropriate time as the patient goes through puberty. The commonest erectile deformity found in epispadias in adult life is tight dorsal chordee. Surgical correction is required. In some patients, adequate correction will be achieved by clearance of superficial pericorporeal scar tissue, possibly aided by Nesbit's procedure. For the remainder, formal correction of the chordee is required. This is best done by the insertion of a gusset of dura or other material to lengthen the concave side of the curve.