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Bizic et al. Plast Aesthet Res 2022;9:14 https://dx.doi.org/10.20517/2347-9264.2021.102 Page 5 of 12

Figure 2. Failed epispadias repair. First stage repair. (A) Failed epispadias repair with ventral curvature. (B) After penile degloving, short
urethra was noted and dissected. Distance between two ends of the urethra is 5.5 cm. (C) Grafting of the corpora cavernosa using
bovine pericardium to correct the penile curvature. (D) Penile and scrotal skin reconstruction using available penile and scrotal skin
flaps. Meatus is positioned ventrally at the base of the penis.

The second stage of epispadias repair was performed six months later and consisted in urethral
reconstruction [Figure 3A]. The missing part of the urethra was reconstructed using buccal mucosa grafts
quilted to the corpora cavernosa, creating the dorsal urethral wall, and an island skin flap harvested from
the scrotal skin over the silicone Foley catheter 12-16 Ch [Figure 3B]. The buccal mucosa graft was
harvested from the patient’s inner cheek in a previously described fashion, defatted, and fixed to the corpora
cavernosa with interrupted 5.0 polidyoxanone suture . The flap pedicle was placed over the urethra and
[6,7]
suture lines to prevent the formation of a fistula [Figure 3C]. Penile skin reconstruction was performed to
avoid suture superposition and to prevent penile curvature using available penile and scrotal skin flaps
[Figure 3D]. A suprapubic urinary catheter was introduced into the bladder for a period of three weeks.
Oxybutynin was administered postoperatively to all patients, to prevent bladder spasms while the catheter
was in place. Elastic-adhesive compression bandage was placed around the penis. The urethra was
moistened every 3 h for the first 72 h during the hospital stay using 0.9% saline solution. Broad spectrum
antibiotics were administered together with metronidazole during the hospital stay. The patients were
instructed on flushing the urethra once daily with a 0.9% saline solution after hospital discharge. Urinary
Foley catheter was removed 10 days after the surgery. Sexually active patients were instructed to refrain
from sexual intercourse for a period of eight weeks postoperatively.