Figure 5 - uploaded by Amilal Bhat
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A1 Showing the spongioplasty with separated corporal bodies. A2 Diagrammatic representation of spongioplasty. B1 Showing straight penis after corporoplasty and glanuloplasty arrows marked showing corpora and corporoplasty suture line. B2 Diagrammatic representation. C1.Urethra and corporal bodies in normal alignment ventrally with conical glans and meatus at the tip. C2. Diagrammatic representation of the same.
Source publication
Introduction and Objective
Objective of the study was to evaluate the functional and cosmetic outcome of single-stage modified partial penile disassembly repair in isolated male epispadias.
Materials and Methods
A retrospective analysis of 15 cases of primary epispadias repair, June 2015 to December 2018 was done. Patients were classified by type...
Citations
Isolated male epispadias is one of the most severe congenital genital anomalies that require surgical correction. The goals of the surgery are to reach good aesthetic and functional outcomes. The aim of this retrospective study was to analyze the long-term outcomes of surgical reconstruction of male epispadias. A total of 31 patients with a mean age of 17 years, who underwent surgical repair of isolated male epispadias from January 2000 to January 2015, were involved. The main outcome measures were defined as: aesthetic outcome, continence, postoperative complications, sexual function, and quality of life. The follow-up period ranged from 8 to 23 years, with an average of 14.4 years. Each patients underwent an average of 2.2 surgical procedures in this period. The most common postoperative complications were urethral fistula and residual curvature, in 22.6% and 12.9%, respectively. Satisfactory aesthetic outcome was reported in 71.4% of cases. The repair of male epispadias usually includes more than two procedures with satisfactory aesthetic outcome. Unsolved urinary incontinence remains a significant issue and has a high impact on the quality of life. Follow-up should be extended even after complete sexual maturity. Comprehensive long-term evaluation is necessary for proper treatment of isolated epispadias.
Introduction
Bladder exstrophy remains one of the most challenging and complex congenital conditions in pediatric urology. Various techniques have been described to reconstruct penile anatomy, yet a high risk of complications remains [1-5]. There is a limited number of articles dedicated to the use of penile disassembly technique by Perovic.
In the presented video, our objective was to demonstrate the improved penile disassembly by Perovic technique.
Material and methods
A 23-year-old male patient presented to the clinic after 5 unsuccessful penile surgeries with dorsal penile curvature and meatus located dorsally. With a circumferential incision along the coronal edge full degloving is performed, and urethral plate is mobilized. Cavernous bodies and neuro-vascular bundles are mobilized. One of the cavernous bodies is detached from the glans. Urethral plate is tubularized until the tip of the glans and deepened below the cavernous bodies. An artificial erection test is performed that shows dorsal curvature. Cavernous bodies are rotated inwards and sutured together to correct curvature. Another artificial erection test is performed which demonstrated a straight penis. Integrity of neuro-vascular bundles is restored, and correct anatomy is reconstructed. Peno-scrotal and peno-pubic junctions are formed. Penile skin is sutured and reconstructed. At the end of the surgery, umbilicoplasty is performed with rectangular skin flap.
The results of the surgery were analyzed in both early- and long-term follow-up of up to 3 years.
Results
In early and 3-year follow-up, the patient had successful results of the treatment – no recurrent penile curvature was recorded, cosmetic result was close to natural, and no edema was present. Some scarring remained due to the high number of previous surgeries.
Conclusions
The improved penile disassembly technique by Perovic allows to get successful both cosmetic and functional results, reconstructing penile anatomy, and decrease the number of post-operative complications preventing recurrence of penile curvature.
