Treatment for Failed Epispadias Repair Presenting in Adults

PurposeWe evaluated the results of 1-stage and multistage penile reconstruction in adults with complications after multiple failed epispadias repairs.Materials and MethodsA total of 23 adults underwent penile disassembly for repeat epispadias repair from February 2006 to June 2011. Median age at surgery was 27 years (range 17 to 41). Surgical treatment included penile disassembly with complete straightening and lengthening of the penis, followed by urethral reconstruction. The corpora cavernosa were completely separated from the glans cap with the neurovascular bundles and from the urethra. The urethra, which was short in all cases, was divided at the glans level. Penile straightening and lengthening were achieved by tunica albuginea incision and grafting. The urethra was reconstructed 3 to 6 months later using combined buccal mucosa graft and genital skin flaps. Success was defined as a functional penis without urethral fistula or stricture, or residual chordee as well as a cosmetically acceptable penile appearance.ResultsMean followup was 33 months (range 14 to 78). Of the patients 19 had a completely straightened and lengthened penis. Improved length of the erect penis was 2.7 to 6.6 cm. In 4 patients mild curvature developed without the need for additional correction. Urethral fistula in 3 cases was repaired 6 months after urethroplasty in 2, while it closed spontaneously in 1. All 21 sexually active patients reported good erectile function.ConclusionsAdults with complications after childhood epispadias repair are still a difficult population to treat. A radical surgical approach must be used to achieve a successful outcome.