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?

Publication date: Available online 2 August 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Smail Acimi, Debbous Lamia, Mohammed Ali Acimi, Amina Leila Khelil

Abstract

Purpose

To assess the importance of shortening of the urethral plate occurred with complete penile disassembly technique in epispadias repair and its impact on cosmetic and functional results (on urinary incontinency).

Methods

From January 2009 to December 2016, 26 boys underwent complete penile disassembly technique for proximal epispadias repair. Twenty-one patients had epispadias after primary repair of bladder exstrophy and 5 isolated peno-pubic epispadias. The age of the patients ranged from 11 months to 6 years (median 3 years).

Results

After disassembling the penis in three parts, the shortening and narrowing of urethral plate were found in all patients, the shortening varied between 2 and 16 mm. However, in isolated epispadias the urethral plate is easily extensible. The cosmetic results (after dehiscence and fistulas repair) were found satisfying in 24 patients with conical glans and meatus in orthotopic position without any necrosis of the glans. However, 18 patients (81.8 % of cases) who had initially a bladder exstrophy presented a dehiscence or fistula. The urinary continence ≥1 h was observed in 5 patients (19% of cases) and only 3 patients (11.5% of cases) had an urinary continence ≥3 h.

Conclusions

The complete penile disassembly procedure restores the normal anatomy of the penis. Despite the shortening and narrowing of the urethral plate the cosmetic results were good in the majority of patients. However, its functional outcomes on urinary incontinence, particularly for epispadias with bladder extrophy remain uncertain.