Page 30 - Read Online

Page 2 of 12 Bizic et al. Plast Aesthet Res 2022;9:14 https://dx.doi.org/10.20517/2347-9264.2021.102

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.

Keywords: Epispadias, primary repair, penile disassembly, urethroplasty, buccal mucosa graft, genital
reconstruction, failed epispadias

INTRODUCTION
Primary epispadias, either isolated or associated with bladder exstrophy, represent a rare congenital genital
anomaly with the incidence of 1 in 117,000 male live births, with a male-to-female ratio of 5:1 in the general
population . It is characterized by a dorsal lack of penile prepuce, ectopic meatus, abnormally positioned
[1]
urethra, dorsal penile curvature, divergence of corpora cavernosa, pubic diastasis, and urinary incontinence
in proximal forms, because of the associated defect of the sphincteric muscle mechanism .
[2]

The origin of exstrophy-epispadias is multifactorial, with both genetic and environmental factors playing a
role . Pregnancy counseling regarding familial recurrence risk should emphasize that exstrophy-epispadias
[1]
complex most commonly occurs as an isolated sporadic birth defect with the risk of recurrence of less than
1% .
[3]

The treatment is exclusively surgical and usually radical depending on the epispadias form. Detailed
knowledge of penile anatomy is of essential importance for successful results. The goal of epispadias repair
is to provide for an adequately functional and cosmetically acceptable penis. Early surgical repair of
congenital genital anomalies is considered to have a positive impact on the patient’s psychosexual
development. Despite the constant development of epispadias repair, high incidence of failure and need for
reoperation characterizes epispadias as one of the most difficult genital anomalies and a great challenge for
pediatric and adult reconstructive urologists. Typically, patients with severe forms of epispadias undergo
more than one surgical repair. Outcomes can be questionable and even worsened after penile growth in
puberty if the corporal deformity was not adequately corrected. Penis size, glans, and overall penile
appearance become more obvious in adolescents and young adults, and their expectations for functional
and esthetically appealing penis impose successful redo epispadias repair .
[4]

This paper presents the latest surgical approaches for epispadias treatment in the pediatric population, as
well as those for the adult population after initial failed repair in childhood.

METHODS
After Institutional Review Board approval was obtained (062021-U/918-2), a retrospective study was
conducted using the institutionally approved database and included all patients treated for isolated
epispadias in our institution from March 2005 to May 2020. The study included 18 patients aged 11-48
months (mean 21 months) (Group A) who underwent primary epispadias repair and 15 patients aged 13-29
years (mean 18 years) (Group B) who underwent redo surgery due to failed epispadias repair in childhood.
Two out of fifteen patients from Group B had exstrophy-epispadias repair in childhood. Included patients
from Group B had a mean of four surgeries for epispadias correction. In all patients from Group B, surgery
was performed as a two-staged epispadias repair. The first stage included correction of the recurrent dorsal