Technical details in the primary repair of male epispadias: Step by step video

Abstract

Objective: the primary correction of male epispadias consists of multiple surgical steps: isolation of the complex corpora-urethral plate, bladder neck plasty if incontinence is associated, tubularization of the urethral plate, correction of dorsal curvature, and skin coverage of the penile shaft. The present video demonstrates our center experience in managing incontinent male epispadias and addresses the above-mentioned technical details to achieve the best possible cosmetic and functional result. In particular, the bladder neck plasty through perineal approach, the correction of curvature by external rotation of the corpora and the penile shaft coverage with rotational skin flap Patient and surgical procedure: a 3-year-old boy was born with an isolated incontinent penopubic epispadias. The epispadias was repaired starting with the isolation of the corpora-urethral plate complex using disassembly technique and external rotation of both corpora to fix the dorsal chordee. In addition, the bladder neck was funneled to treat the incontinence. Dorsal skin coverage was achieved using penile skin rather than the redundant ventral prepuce. Result: the boy had an excellent outcome with no urethrocutaneous fistula or recurrence of dorsal chordee at one-year follow-up post-surgery. Conclusion: the described surgical steps allowed dorsal skin closure using the lateral rotation of ventral penile skin flap to improve cosmesis after epispadias repair and avoid the recurrence of chordee secondary to midline dorsal scarring

Keywords

• Male epispadias
• Urinary incontinence
• Dorsal penile curvature
• External corporeal rotation