V09-06: The Mitchell Complete Penile Disassembly for Epispadias Repair
Epispadias repair aims to restore normal penile anatomy, achieve straight erections with excellent cosmesis and improve urinary continence. The complete penile disassembly technique allows for ventral positioning of the urethra and correction of severe dorsal chordee, however the resultant hypospadic meatus requires further reconstruction. We describe the technical refinements of the complete penile disassembly technique for epispadias repair with the use of buccal mucosal graft and ventral skin flap.
After penile degloving, the urethral plate was dissected and detached from the corpora cavernosa which were separated. The urethra was tubularized and ventrally positioned. A buccal mucosal graft was harvested and quilted to the corpora cavernosa distal to the neomeatus. Skin coverage was achieved with a ventral preputial transverse island flap rotated dorsally. The buccal graft was tubularized 6 months later.
The technique was successful to achieve an excellent aesthetic outcome with an orthotopic meatus and a conical glans in 2 stages. The patient eventually had straight erections and improved continence. Neither procedure had complications.
Excellent cosmetic and functional outcome can be achieved with complete penile disassembly for epispadias repair. Buccal mucosal graft urethroplasty is a feasible option to correct the resultant hypospadias. A ventral preputial island flap allows for adequate skin coverage while avoiding a dorsal midline scar.