Modified Cantwell-Ransley Repair of Male Penopubic Epispadias: Report of Two Cases and Review of the Literature

Abstract

Abstract:The reported incidence of male epispadias is 1 in 1,17,000 male births. The majority of cases go unseen in surgeons' life because of uncommon existence of this anomaly. We present our experience using the modified Cantwell-Ransley technique; particularly focusing on postoperative anatomical and functional outcomes. Between 2011 and 2013, two boys having primary penopubic epispadias with the spraying of urinary stream underwent one stage surgical reconstruction. Cavernocavernostomy was performed in all cases as a part of a procedure to correct dorsal curvature and for penile lengthening, but none of them required bladder neck procedure. At 3 rd and 6 th month follow-up period both of them found to have significant step forward subjective and objective outcomes. The cosmetic appearance of the phallus was not satisfactory in one case and it is because post-operatively the patient developed necrotic patches over the glans and neourethral skin that healed with fibrosis.

Modified Cantwell–Ransley repair for isolated continent epispadias in adult: Our experience

“…[14] In our series, no patient developed fistula or stricture (although our series comprises of five cases only) similar to findings of Pippi Salle et al [18] In the report of two cases of epispadias repair by modified Cantwell-Ransley by Lodh et al, there is no fistula or need for any dilatation post-operatively. [4] Only one patient had superficial infection of dorsal penile skin which healed by secondary intention and did not require a secondary procedure in our series. In series of Nerli et al of 43 cases treated by similar technique found dorsal skin infection or incision separation in three children and none required a secondary procedure in his series.…”

“…[7] Several surgical procedures have been described till date but treatment for this anomaly is far from trival and repair can be challenging. [4] The goal of surgery is to achieve functionally and cosmetically acceptable penis. [8] The first description of epispadias repair is by Cantwell in 1895 till then techniques evolved through various modification.…”

“…Finally, there are two popular techniques described in literature, that is, modified Cantwell-Ransley which involves partial penile disassembly of penis and placement of urethra in more normal position and the second most recent evolution is complete penile disassembly. [4] Despite the versatility of Mitchell technique, it may lead to ischaemic changes to distal glans, loss of glans or corpora and the shortening of urethral plate with resultant hypospadias have been reported. [9] The Cantwell-Ransley repair is an excellent, most popular and widely used approach to treat epispadias compared to other standard methods.…”

“…[ 2 3 ] Many surgical techniques have been described for the repair of the male epispadias of which modified Cantwell–Ransley has become the procedure of choice. [ 4 ]…”

“…[2,3] Many surgical techniques have been described for the repair of the male epispadias of which modified Cantwell-Ransley has become the procedure of choice. [4] We are presenting results of our experience in performing modified Cantwell-Ransley repair in five continent adult males having various types of isolated epispadias and for its rarity.…”