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Page 8 of 12 Bizic et al. Plast Aesthet Res 2022;9:14 https://dx.doi.org/10.20517/2347-9264.2021.102

RESULTS
Follow-up ranged from 15 to 197 months (mean 88 months). Satisfactory results in terms of cosmesis and
function were achieved in 15 patients from Group A and in 11 patients from Group B. Voiding function
was adequate except in two patients from Group A with penopubic epispadias who were incontinent.
Uroflowmetry in Group A showed mean values of Qmax 12 mL/s (range 8-18 mL/s), while in Group B
showed mean values of Qmax 19 mL/s (range 13-25 mL/s). Continence was present in all but two patients
with penopubic epispadias, who were above the age for toilet-training. Mean preoperative penile length in
erect state in Group B was 9.6 cm (range 7.1-10.2 cm), while postoperative length in erection was increased
by a mean of 3.6 cm (range 2.6-6.5 cm). Recurrent penile curvature was seen in two patients from Group A
and required surgical repair and in two patients from Group B, but it was mild and patients did not report
difficulties in penetrative sexual intercourse. Urethral fistula occurred in four patients from Group A and in
three patients from Group B. Surgery to repair fistula was performed after at least four months of complete
healing after initial surgery. In one patient from Group B, fistula repair required two surgical repairs. One
patient from Group B developed urethral stenosis that required surgical repair. Partial glans dehiscence
developed in one patient from the Group A. Partial skin dehiscence developed in five patients, three from
Group A and two from Group B [Table 1]. All patients from Group B who filled the IIEF questionnaire (11
patients) reported satisfying erectile function, sexual desire, intercourse, and overall satisfaction. Two out of
eleven patients from Group B reported low ejaculatory function on the IIEF questionnaire.

DISCUSSION
Many surgical techniques are described for epispadias repair, with various success rates. The literature is still
lacking data and success rates regarding isolated epispadias repair. However, we obtained some data on
bladder exstrophy-epispadias repair . A high rate of postoperative complications makes epispadias repair
[9]
still challenging even for experienced reconstructive urologists, as it presents one of the most severe
congenital genital anomalies. Any surgical approach considered for epispadias repair should address the
following cornerstones: correction of the dorsal penile curvature, urethral reconstruction (including
continence), glansplasty, and penile shaft reconstruction [10,11] . The repair should be performed during the
first year of life, based on experts’ opinion [9,12] .

Despite the large number of surgical techniques for primary epispadias repair, two approaches are mostly
used by the majority of specialist urology centers: the modified Cantwell-Ransley approach and the
Mitchell-Bagli approach [12-14] .

Cantwell’s epispadias repair consists of mobilizing urethra positioned dorsally and its tubularization and
[15]
placement ventrally in a hypospadiac position, while corpora cavernosa are joined over it . Almost one
century later, Ransley made the modification of Cantwell’s approach by tubularization of the most distal
part of the urethral plate in transverse fashion, creating the reversal meatal advancement and glansplasty
[1]
(IPGAM) . Further repair includes mobilization of the corpora cavernosa and correction of the dorsal
curvature by incisions on tunica albuginea at the point of maximum deformity and subsequent suturing of
the corpora cavernosa above the urethra completing cavernosocavernosostomy . In their study,
[16]
Gearhart et al. performed Cantwell-Ransley epispadias repair in 75 boys with postoperative fistula in 21%.
[11]
The same center reported the use of modified Cantwell-Ransley epispadias repair in 129 patients, of whom
97 were exstrophy epispadias cases and 32 isolated epispadias with the incidence of 13% of postoperative
fistula in epispadias group .
[17]