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Bizic et al. Plast Aesthet Res 2022;9:14 https://dx.doi.org/10.20517/2347-9264.2021.102 Page 7 of 12

Figure 4. Patient with previously operated exstrophy epispadias complex. First stage repair. (A) Preoperative appearance. Excessive skin
positioned ventrally. (B) Short superficial urethra positioned dorsally. (C) Partial penile disassembly. Both corpora cavernosa divided
without detachment of the glans. Urethra transposed ventrally. (D) Final aspect. Meatus positioned ventrally at the penoscrotal angle
forming hypospadias. Penile skin reconstruction using available penile skin flaps keeping the excessive skin ventrally for the second stage
urethroplasty.

Figure 5. Second stage repair. (A) Dissection of the urethral plate (penile skin) and its tubularization over the silicone Foley catheter.
(B) Complete tubularization of the urethra and meatal advancement. (C) Appearance at the end of surgery. Penile shaft reconstructed
using available penile skin flaps.

described. Broad spectrum antibiotics were administered during the hospital stay. The patients were
instructed on flushing the urethra with a 0.9% saline solution after hospital discharge. Silicone stent was
removed from the urethra 10 days after the surgery. Sexually active patients were also instructed to abstain
for a period of eight weeks after the second stage of repair. Absence of a urethral fistula and/or stricture and
residual curvature with an appealing penile appearance was considered as successful repair. Follow-up visits
were at 3, 6, 9, and 12 weeks. then every 3 months during the first postoperative year, and yearly thereafter.

Sexually active patients aged 16 years and above (able to sign informed consent) were interviewed regarding
the quality of their sex life and satisfaction using the International Index of Erectile Function (IIEF)
questionnaire , while, in younger patients, uroflowmetry was performed to confirm adequate voiding
[8]
function, in addition to recording parents’ reports considering presence/absence of the curvature and penile
appearance.