Abstract:
OBJECTIVE:To report a novel surgical approach for single-stage repair of exstrophy-epispadias, with the specific aim of innervation, preserving sphincteroplasty corporal detachment for penile lengthening and ischio-pubic ramotomy for Linia-alba approximation. MATERIAL AND METHODS:Twenty-five classic exstrophy with compliant bladder plate and 10 incontinent epispadias patients were selected. Preoperative magnetic resonance angiogram of urogenital diaphragm showed triangular space between ischio-cavernosus, bulbo-spongiosus, and transverse-perinei muscles containing sphincteric branch of perineal artery indicating the course of sphincteric nerve. Bladder plate was mobilized. Through a midline scrotal septal and transverse incision along the base of urogenital triangle, the urogenital diaphragm was exposed. Corpora were separated from the urethral plate while preserving the glanular continuity and innervation to striated urethral sphincter, using muscle stimulator and nerve integrity monitor. In the subperiosteal plane along the ischio-pubic rami, the corpora were detached. Repair included ureteric reimplantation; anatomic reconstruction of bladder, bladder neck, urethra, and striated sphincter; corporo-glanuloplasty; ischio-pubic ramotomy; and abdominal closure. Assessment included surgical problems, cosmetic satisfaction, erectile function, continence, and upper tract status at 2-year follow-up. RESULT:There was no corporal loss. Postoperative complications included 4 perineal suture line infections, 11 peno-pubic fistula, and 1 adhesive intestinal obstruction. Erectile function was good in 33 patients. Penile length was gratifying in 25. Of 28 patients, 20 (71.4%) had dry interval of two hours. Dimercaptosuccinic acid study demonstrated upper tract scarring in 2 patients. CONCLUSION:This approach facilitates innervation preserving sphincteroplasty and precise restoration of anatomy to near normal without operative accidents because of wide exposure gained, improving the functional and cosmetic results.
journal_name
Urologyjournal_title
Urologyauthors
Kureel SN,Gupta A,Kumar S,Singh V,Dalela Ddoi
10.1016/j.urology.2010.12.086subject
Has Abstractpub_date
2011-09-01 00:00:00pages
668-74issue
3eissn
0090-4295issn
1527-9995pii
S0090-4295(11)00252-4journal_volume
78pub_type
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