Complete penile disassembly for epispadias repair: the Mitchell technique

Area of Science:

• Urology
• Pediatric Surgery
• Reconstructive Surgery

Background:

• Epispadias is a congenital condition requiring complex surgical repair.
• Existing techniques may have limitations in achieving optimal functional and aesthetic outcomes.
• The unique vascularity of the corpus cavernosum and glans offers potential for innovative surgical approaches.

Purpose of the Study:

• To present a new surgical technique for epispadias repair.
• To utilize the distinct blood supply of the corpus cavernosum and glans in the repair.
• To address limitations of previous epispadias repair methods.

Main Methods:

• A technique involving complete disassembly of the epispadiac phallus into three components: urethral plate, and right and left hemicorporeal glandular bodies.
• Surgical repair was performed on ten boys aged 10 months to 17 years.
• One patient had concurrent bladder exstrophy closure; two had prior para-exstrophy flap procedures.

Main Results:

• Follow-up ranged from 8 to 57 months.
• Eight patients achieved a conical glans, one had a straight shaft, and seven had a ventral orthotopic meatus.
• Three fistulas occurred in two secondary repair patients, successfully managed outpatient.
• All patients reported preserved potency.

Conclusions:

• Complete disassembly facilitates independent repair of the glans and urethra.
• This technique allows for tubularization and ventralization of the distal urethra.
• Separation of corporeal glandular bodies aids in releasing rotational forces causing dorsal chordee.
• Improved surgical exposure for procedures like corporotomy or dermal grafting is achieved.