Surgical outcomes of Subsymphyseal Urethral Reconstruction (SURE) in isolated female epispadias: evaluation of continence scoring.

Objective: To assess the long-term urinary continence of patients operated for isolated female epispadias using novel approach of distal urethral lengthening along with the incorporation of deeper periurethral muscles over the native urethra. Occurrence of UTI and stress incontinence too were assessed as secondary outcomes.

Methodology: All girls diagnosed with isolated female epispadias, who underwent epispadias repair, and completed follow-up period of minimum 2 years, were included in this study. Their long-term continence was assessed using a validated questionnaire. The study group patients underwent distal urethroplasty using hairless skin of mons along with incorporation of deep periurethral tissue. Bladder neck reconstruction was added in initial patients with minor variant (type 2 of Davis classification) and in patient with cleft extending till bladder neck (type 3 of Davis classification). Five of the patients with type 2 defects were managed only with urethroplasty.

Results: At a mean follow up of 7.4years all patients with type 2 epispadias (Davis classification) are continent and void on desire. None of them are having UTI or stress incontinence. Patient with type 3 epispadias is incontinent with dry interval of less than 30 min and awaiting augmentation cystoplasty.

Conclusion: Simple urethral reconstruction with inclusion of hairless skin over mons and deeper peri-urethral soft tissue might be sufficient to restore sphincteric function in minor variants of isolated female epispadias. More extensive procedures may be reserved for the most severe cases.