The management of erectile deformity in adults with exstrophy and epispadias

The management of 20 patients with erectile deformities owing to exstrophy and epispadias is described. The type of deformity was defined by cavernosography and intraoperative artificial erections. Of the 20 patients 15 had dorsal chordee, 2 had lateral deviation (1 also had dorsal chordee) and 3 had bilateral rudimentary corpora producing small and inadequate erections. The latter 3 patients were considered inoperable. Of the 15 patients with dorsal chordee 12 were treated by insertion of lyophilized human dura in the concave side of the corpora. The results were good after 1 attempt in 8 and after 2 attempts in 1, while 1 had recurrent chordee distal to the first site and further dural phalloplasty was successful, 1 was improved and 1 was a failure. Of the remaining 3 patients in this group 2 underwent excision of scar tissue (1 also had a ventral Nesbit procedure) and the condition was not bad enough to require an operation in 1. Of the 2 patients with lateral deviation 1 was treated by division of a rudimentary corpus and dural phalloplasty of the normal corpus, which produced a straight but rather unstable erection, and 1 underwent bilateral dural phalloplasty with a good result.