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Male epispadias: experience with 45 cases

P Mollard1, T Basset, P Y Mure

  • 1Hôpital Debrousse, Chirurgie Pédiatrique, Lyon, France.

The Journal of Urology
|June 17, 1998
PubMed
Summary

This study shows that surgical repair of isolated male epispadias, particularly using modified Cantwell-Young-Gross principles, significantly improves continence and sexual function. The modified techniques offer better outcomes than older methods.

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Area of Science:

  • Urology
  • Pediatric Surgery
  • Reconstructive Surgery

Background:

  • Isolated male epispadias is a congenital condition affecting the urethra.
  • Surgical management aims to restore urinary continence and penile function.
  • Previous surgical techniques have shown variable long-term success rates.

Purpose of the Study:

  • To evaluate the long-term outcomes of surgical interventions for isolated male epispadias.
  • To assess the efficacy of different urethroplasty techniques in achieving continence and functional reconstruction.
  • To compare surgical results for isolated epispadias with those for epispadias associated with exstrophy.

Main Methods:

  • A retrospective review of 45 male patients with isolated epispadias treated between 1971 and 1993.
  • Incontinence was addressed with modified Young-Dees bladder neck reconstruction and ureteral reimplantation.
  • Various urethroplasty techniques were employed, including Cantwell-Young-Gross, Duplay, skin grafts, bladder grafts, and Cantwell-Ransley procedures.
  • Penile reconstruction involved single-stage or two-stage approaches.

Main Results:

  • Of 13 incontinent patients, 11 achieved continence post-surgery.
  • Urethroplasty success was 66% immediately, with 25% minor and 10% serious complications.
  • Long-term follow-up in 29 patients showed all had erections, 24 engaged in sexual intercourse, 17 had normal ejaculations, and 4 fathered children.
  • Genital cosmesis was generally considered acceptable.

Conclusions:

  • Modified Cantwell-Young-Gross and Ransley principles significantly enhance penile reconstruction for isolated male epispadias.
  • Free graft and Duplay urethroplasties yielded unsatisfactory results in this series.
  • Surgical success rates for incontinence in isolated male epispadias (84%) surpassed those for male exstrophy (63%).

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