[Congenital epispadias with urinary incontinence: long-term results of reconstructive therapy]

The author investigated the long-term results after reconstruction operations in epispadias with total urinary incontinence in 16 pediatric patients-4 girls and 12 boys. The patients were operated in 1961-1981 at the Department of pediatric surgery of the University Hospital in Hradec Králové. The operations were made most frequently between the age of 3 and 4 years. Straightening of the penis was achieved by exstirpation of the dorsal chorda and by V-Y plasty. To lengthen the penis it proved useful to separate the greater portion of the crura from the bony rami. To achieve functional continence plastic operations were made of the posterior urethra and of the bladder neck in patients of both sexes. The Young-Dees procedure proved best. The overall continence rate was achieved in 70% of operated boys and in 60% of girls. The functional failure of reconstruction was treated by secondary diversion in 2 cases, in one by ureterosigmoideostomy and in one by ileal conduit. The associated VUR reflux was corrected by Politano-Leadbetter's UCN or by the Cohen procedure. From the social aspect the patients are well adapted, they completed their training for a job. Of 12 patients where an inquiry for further information was made, with the exception of one patient, all are active in their sexual life. Seven patients are married, five men fathered 7 children and two female patients were delivered of three healthy children.