Epispadias repair with tunica vaginalis flap
R S Zee1, J H Makari2, Fernando Ferrer2
1Department of Urology, University of Virginia School of Medicine, Charlottesville, VA, USA.
Insights
This video demonstrates a modified Cantwell-Ransley technique for primary epispadias repair in a pediatric patient. The procedure, adhering to established principles, resulted in an optimal surgical outcome with an unremarkable recovery.
Area of Science:
- Pediatric Urology
- Congenital Malformations
- Surgical Techniques
Background:
- Primary epispadias is a rare congenital malformation affecting approximately 1 in 80,000 children.
- The Cantwell surgical repair, established over a century ago, provides a foundational approach for treating epispadias.
- Optimal surgical outcomes rely on adherence to specific, time-tested surgical steps.
Observation:
- A 9-month-old male with penopubic epispadias underwent surgical repair.
- Pre-operative imaging confirmed a normal renal ultrasound and voiding cystourethrogram findings.
- A modified Cantwell-Ransley approach was utilized, preserving penile structures and relocating the urethral plate.
Findings:
- The modified Cantwell-Ransley technique involves identifying neurovascular bundles, preserving the ventral mesentery, and mobilizing the urethral plate.
- A tunica vaginalis flap was incorporated to reinforce the urethral repair.
- The procedure was performed successfully as an outpatient with a straightforward postoperative course.
Implications:
- This video showcases a refined surgical method for primary epispadias repair.
- The continued application of Cantwell's principles ensures excellent results in pediatric epispadias surgery.
- The modified technique offers a viable option for achieving optimal functional and cosmetic outcomes in affected children.
Introduction:
Primary epispadias is a rare congenital malformation that afflicts about 1 in 80,000 children. The surgical repair, originally described by Cantwell over 100 years ago, is fundamentally sound and incorporates several important steps to achieve an optimal result.
Methods:
A 9-month-old male with penopubic epispadias presented for surgical repair. Pre-operative imaging included a normal renal ultrasound and voiding cystourethrogram that demonstrated a moderate-sized bladder, partially competent bladder neck, and no vesicoureteral reflux. A modified Cantwell-Ransley approach to the repair was performed without complete disassembly of the penis. Established surgical principles of identification of laterally placed neurovascular bundles, preservation of the ventral mesentery to the urethral plate, mobilization of the urethral plate off the corporal bodies with ventral relocation, and dorsal medial rotation of the corporal bodies are demonstrated in this video.
Results:
This procedure was performed as an outpatient. The patient had an unremarkable postoperative course. The #6-French urethral stent was removed on postoperative day 10.
Conclusions:
This video demonstrates a modified Cantwell-Ransley technique for epispadias repair, which employs a tunica vaginalis flap to reinforce the urethral repair. The adherence to surgical principles described by Cantwell in the late 1800s for children with primary epispadias continues to lead optimal surgical outcomes.
