[Surgical treatment of epispadias].

Abstract

The anatomy and pathophysiology of epispadic urethra and bladder is presented. The operative procedures used for correction of the genital deformity and coexisting incontinence are described. The controversial points concerning the staging of procedures, the choice of optimal time and technic is discussed, with the results reported in recent series. In the Surgical Clinic of the Institute of Mother and Child 15 children with epispadias were treated during 1969-1979. There were 12 males and 3 females. 13 children had complete peno -pubic epispadias, with prolapse of bladder mucosa in two of them. Thery were totally incontinent. Amongst two boys with partial penile deformity 1 had bladder control. IVP showed no abnormalities, excluding solitary kidney in one boy. Cystography revealed wide bladder neck and short urethra with dilation of its posterior part; transient vesico-ureteral reflux was observed in 2 patients. Two children with prolapsing bladder mucosa were operated on when 6 and 14 months old. The age of remaining 13 children at the time of surgery was: between 3,5 and 6 years in 7, 6-9 years in four, the oldest two were 10 and 12. The Cantwell -Young reconstruction of the urethera was usually performed, with mobilizing of corpora cavernosa. In 5 children it was combined with wedge resection of anterior bladder neck and in 4 with infra-pubic wedge excision of dilated anterior urethera and Mayo plasty of external sphincter. The Young- Dees operation was performed twice, as a secondary procedure for treatment of total incontinence. During follow up the gradual improvement of bladder control was observed. Continence was achieved in 5, including 2 children after Young- Dees plasty. 3 children have stress incontinence, another 3 are dry at night and at rest, but wet during normal activities, 1 is totally incontinent.(ABSTRACT TRUNCATED AT 250 WORDS)