Is there a shortening of the urethral plate in complete penile disassembly used in epispadias repair, and what is its impact on the final outcomes?

Acimi, Smaïl; Debbous, Lamia; Acimi, Mohammed Ali; Khelil, Amina Leila

doi:10.1016/j.bjps.2018.07.002

Cited by 5 publications

(6 citation statements)

References 16 publications

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“…Characteristics of the urethral plate, such as length and width, will determine the reconstruction type. In cases of the short urethral plate, most authors will form a hypospadiac meatus and will, in further reconstruction, create an orthotopic meatus on the tip of the glans using some flaps and graft techniques [21]. According to our study, 35.5% of patients had hypospadiac meatus due to a short urethral plate.…”

Section: Discussionmentioning

confidence: 66%

“…Afterwards, a follow-up should be conducted to correct any complications influencing the patients' functional and psychological issues. Many surgical centers treating epispadias reported satisfactory results after the complete penile disassembly technique [2,5,6,11,[21][22][23][24]. Most published studies analyzed short-term results of epispadias repair in the past, but currently, authors are paying more attention to the long-term outcomes [2,[8][9][10][11].…”

Section: Discussionmentioning

confidence: 99%

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Isolated Male Epispadias Repair: Long-Term Outcomes

Bencic,

Bizic,

Joksic

et al. 2024

Life

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Isolated male epispadias is one of the most severe congenital genital anomalies that require surgical correction. The goals of the surgery are to reach good aesthetic and functional outcomes. The aim of this retrospective study was to analyze the long-term outcomes of surgical reconstruction of male epispadias. A total of 31 patients with a mean age of 17 years, who underwent surgical repair of isolated male epispadias from January 2000 to January 2015, were involved. The main outcome measures were defined as: aesthetic outcome, continence, postoperative complications, sexual function, and quality of life. The follow-up period ranged from 8 to 23 years, with an average of 14.4 years. Each patients underwent an average of 2.2 surgical procedures in this period. The most common postoperative complications were urethral fistula and residual curvature, in 22.6% and 12.9%, respectively. Satisfactory aesthetic outcome was reported in 71.4% of cases. The repair of male epispadias usually includes more than two procedures with satisfactory aesthetic outcome. Unsolved urinary incontinence remains a significant issue and has a high impact on the quality of life. Follow-up should be extended even after complete sexual maturity. Comprehensive long-term evaluation is necessary for proper treatment of isolated epispadias.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Isolated Male Epispadias Repair: Long-Term Outcomes

Bencic,

Bizic,

Joksic

et al. 2024

Life

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“…Because of the short urethral plate, Mitchel-Bagli penile disassembly could lead to resultant hypospadias in 36%-77% of cases, as reported in several other studies [19][20][21] . In the study by Braga et al [22] , published in 2008, they analyzed the treatment of isolated epispadias repair using one of the above-mentioned surgical approaches for epispadias repair. They reported that 67% of their patients treated by Mitchel-Bagli technique became continent, vs. 0% treated by modified Cantwell-Ransley approach.…”

Section: Discussionmentioning

confidence: 99%

“…They reported that 67% of their patients treated by Mitchel-Bagli technique became continent, vs. 0% treated by modified Cantwell-Ransley approach. Furthermore, 48% of their patients from both groups developed complications during the followup period, 57% from the Cantwel-Ransley group and 29% from the Mitchel-Bagli group [22,23] .…”

Section: Discussionmentioning

confidence: 99%

Epispadias: recent techniques

Bizic¹,

Stojanovic²,

Bencic³

et al. 2022

PAR

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Aim: This paper presents the latest surgical approaches for epispadias treatment in the pediatric population, as well as those for adolescent and adult populations after initial failed repair in childhood. Methods: The retrospective study was conducted between March 2005 and May 2020 and included 18 patients with the mean age of 21 months (range 11-48 months) (Group A), who underwent primary epispadias repair and 15 patients with the mean age of 18 years (range 13-29 years) (Group B), who underwent redo surgery after failed epispadias repair in childhood. In Group A, the surgery was performed as a one-stage procedure using complete penile disassembly technique, while, in Group B, the surgery was done as a two-stage procedure and included complete straightening and lengthening of the penis, followed by urethral reconstruction. Penile straightening and lengthening were achieved by tunica albuginea incision and grafting. In Group A, the urethral plate was mobilized, transposed ventrally, and tubularized and augmented with vascularized preputial skin flap where needed. In Group B, the urethra was reconstructed either using the buccal mucosa graft and genital skin flaps or with tubularization of genital skin flaps. Successful treatment was defined as a functional and esthetically acceptable penis without complications. Results: The mean follow-up was 88 months (range 15-197 months). Satisfactory results were achieved in 26/33 patients. Urethral fistula occurred in 4/18 patients from Group A and in 3/15 patients in Group B and was surgically repaired after four months. Skin dehiscence occurred in eight patients, five from Group A and three from Group B. Recurrent penile curvature was observed in 2/18 patients from Group A and required surgical correction and in 2/15 patients from Group B and was mild and did not need surgical repair. Eleven patients from Group B who filled out the International Index for Erectile Function reported satisfying erectile function, sexual desire, intercourse, and overall satisfaction. Conclusion: Primary or redo epispadias repair is challenging even for experienced reconstructive urologists. Only radical surgical approach can lead to complete correction of all deformities and provide successful outcome.

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“…Any disruption of blood supply may lead to tissue hypoxia and activation of pro-inflammatory cytokines, increasing the possibility of penile loss, urethral plate shortening, and reduction of corporal elasticity [ 27 ]. Furthermore, Acimi et al showed shortening and narrowing of the urethral plate in all members of their study group, and Hafez et al observed this phenomenon in one-third of their patients following complete penile disassembly [ 28 , 29 ]. In the present study, we did not completely separate the corpora cavernosa and left the distal 1 cm attached.…”

Section: Discussionmentioning

confidence: 99%

Introduction of a modified single stage reconstruction technique of male penopubic epispadias

et al. 2022

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Objective To represent the long-term outcomes of our modified single-stage technique for the reconstruction of isolated penopubic epispadias in male patients. Patients and methods Data from 113 patients were obtained from bladder-exstrophy-epispadias database of our tertiary center. A total of seven boys with isolated penopubic epispadias with no prior history of surgery and any other anomaly underwent our modified surgical approach from February 1997 to September 2019. The mean ± SD age at surgery was 6.5 ± 2.4 years. Volitional voiding status and cosmetic appearance were evaluated at each follow-up interval. Postoperative follow-up was performed at quarterly intervals in the first year and once a year in subsequent years. Results The mean ± SD of follow-up was 8.5 ± 6 years. All boys who were incontinent achieved urinary control and the ability of normal transurethral micturition following the surgery. Four boys became completely dry, and the other three attained social dryness. Postoperative mean (SD) bladder capacity was significantly increased from 54.5 (11) to 124 (40.0) within 6 months, and to 194 (47.5) at 18 months after surgery. Dorsal curvature has been resolved in all cases, and no postoperative complications were noted except for surgical site infection in one patient treated with antibiotics and bilateral vesicourethral reflux resolved after injection of bulking agents. Four patients had normal erectile function and ejaculation, while the others have not reached puberty yet. Moreover, none of the patients developed urethrocutaneous fistula, stricture, or penile ischemia. Conclusion The present findings suggest the safety and effectiveness of the combination of single-stage urethro-genitoplasty, bladder neck plication, and fat pad pedicled flap in management of boys with isolated penopubic epispadias that can lead to the achievement of urinary control, acceptable sexual function, and cosmetically satisfactory genitalia. Minimal morbidity, low complication rate, and promising outcomes are essential factors, supporting the notion of introducing this technique as a valid option for management of this entity.

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Is there a shortening of the urethral plate in complete penile disassembly used in epispadias repair, and what is its impact on the final outcomes?

Cited by 5 publications

References 16 publications

Isolated Male Epispadias Repair: Long-Term Outcomes

Isolated Male Epispadias Repair: Long-Term Outcomes

Epispadias: recent techniques

Introduction of a modified single stage reconstruction technique of male penopubic epispadias

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