Experience with isolated male epispadias repair: case report from Northern Tanzania

Isolated male epispadias is a rare congenital condition where the urethral opening is abnormally on the upper penis side. Its severity varies, affecting continence and often requiring surgery. Outcomes depend on severity, voiding problems, and the surgeon's expertise.

Two boys, aged 7 and 9, each presented with abnormal urethral opening on the dorsum of the penis, with abnormal urinary stream (bent upwards), without a history of prior surgeries, which was consistent with isolated epispadias. Clinical evaluations revealed a subcoronal meatus on the dorsum of the penis for the first case, and the coronal meatus for the second. The preoperative workups were normal, and there was no pubic symphysis diastasis for either case, and both were continent. The surgical repair involved urethral plate tubulization, neourethra ventralization, glanuloplasty, and circumcision using the modified Cantwell-Ransley technique. Postoperative outcome was successful, with good functional and cosmetic results.

About 90% of congenital anomalies occur in low- and middle-income countries, including Tanzania, where urethral anomalies affect 24% of children and 0.5% present with epispadias. Diagnosis relies on clinical evaluation, while management involves surgical correction, most effectively using the modified Cantwell-Ranseley technique, which preserves urethral blood supply and achieves excellent functional outcomes.

Early diagnosis and surgical repair of isolated male epispadias, even in resource-limited settings, can result in excellent functional and cosmetic outcomes using standard reconstructive techniques.