V7-04: Multi-Institutional Bladder Exstrophy Consortium: Technical Standardization of Distal Epispadias Repair in a Boy
Distal male epispadias is a relatively rare entity in the spectrum of exstrophy-epispadias complex. We present a video of a recent distal male epispadias repair that includes skin closure with a rotational skin flap as described by Salle. Preoperative videourodynamics had demonstrated a marginally continent bladder neck, but otherwise normal bladder function.
Technique was male epispadias repair without osteotomy performed at 9 months of life. No pelvic diastasis was present. High-definition video recording was used for real-time local and remote observation and future teaching, analysis, and review as part of the Multi-Institutional Bladder Exstrophy Consortium (MIBEC).
Our video demonstrates the repair of a mid-shaft distal male epispadias. The penis was initially degloved with a dorsal incision that circumscribes the urethral plate. The corpus spongiosum was then carefully separated off the corpora cavernosal bodies ventrally before moving dorsally. The proximal extent of dissection was the penopubic junction. The corpus spongiosum with dorsal urethral plate was isolated on a vessel loop. Distally, glans wings were made. The glans was never completely disassembled from the corpora cavernosal bodies. A urethroplasty was performed over an 8F urethral stent, and then replaced with a 6F stent that was sutured in place. Next, the neo-urethra and neo-meatus were advanced distally and the urethral plate situated more ventrally. Glansplasty was performed followed by reapproximation of corpora cavernosal bodies dorsally over the urethra without significant medial rotation. Finally, a ventral transverse island penile shaft skin flap was rotated 270 degrees counterclockwise around the penis using the technique of Salle to form a lateral-lying suture line. Three months later the meatus appeared orthotopic and the repair had healed well, with the exception of a small noticeable scar at the location of the suture line of the Salle skin flap (Figure 1).
Distal male epispadias repair can be performed effectively in the setting of MIBEC. High-quality video recording of such rare repairs can aid in future teaching and review. The Salle skin closure offers promise to avoid a dorsal penile shaft scar but requires long-term outcomes.
Funding: NIDDK T32-DK-007785-14