Page 32 - Read Online

Page 4 of 12 Bizic et al. Plast Aesthet Res 2022;9:14 https://dx.doi.org/10.20517/2347-9264.2021.102

Figure 1. Penopubic epispadias. (A) Preoperative appearance of the patient with penopubic epispadias. (B) Complete penile
disassembly. Glans with neurovascular bundles. Both corpora cavernosa completely detached from the glans and mobilized urethral
plate. Silicone urinary catheter placed inside the urethra. (C) Correction of dorsal curvature using grafting technique. Both corpora joined
and derotated. Glans with two neurovascular bundles positioned dorsally. (D) The urethral plate is transposed ventrally and fixed to the
corpora cavernosa. (E) Tubularization of the urethral plate over the silicone catheter. Glans is fixed to the corpora cavernosa.
Glansplasty forming conical glans is finished. Gap between tubularized urethral plate and glans is visible and is approximately 2 cm long.
(F) Mobilization of the preputial skin flap for urethral reconstruction. (G) Urethroplasty is completed using preputial island skin flap that
is anastomosed proximally to the tubularized urethral plate and distally with the glandial part of the urethral plate. Tubularization is
performed around the urinary catheter. Suture lines are covered with vascular subcutaneous tissue. (H) Outcome at the end of surgery.
The urethral stent is positioned in the neourethra. The penile shaft is reconstructed using available penile skin.

degloving was performed with caution to prevent penile skin devascularization. If urethra was short and
presented the limiting factor for maximal straightening of the corpora cavernosa, it was transected at the
subcoronal level [Figure 2B]. Artificial or pharmacological erection introduced by prostaglandin E1 (PDE1)
was performed and recurrent curvature, present in the majority of redo cases, was noted . Curvature
[4]
correction using bovine pericardium to cover the incision defects on tunica albuginea led to a complete
straightening of both corpora cavernosa and allowed for penile lengthening, preventing shortage of the
penis. Complete correction of the curvature was confirmed using artificial or pharmacological (PDE1)
erection [Figure 2C]. The short urethra was transposed ventrally creating new a “hypospadiac” meatus at
the base of the penis. The penile shaft was reconstructed using available penile and scrotal skin flaps
[Figure 2D]. Silicone Foley Ch 12-16 catheter was introduced into the bladder. Elastic-adhesive compression
bandage was placed around the penis to prevent swelling and lymphedema. In postoperative recovery, the
patient was instructed to use a penile vacuum device for a period of six months after the surgery and before
the second-stage repair and to perform permanent hair removal by laser epilation or electrolysis.