Introduction & Objective : Epispadias repair, using the complete penile disassembly technique, is frequently combined with primary bladder closure in patients with classic bladder exstrophy (CBE). Yet, penile disassembly has been posited as a risk for penile injury by ischemic mechanisms. Herein, the authors present all CBE cases referred to their institution where primary closure with penile disassembly epispadias repair was complicated by penile injury.
Methods : A prospectively maintained institutional database of 1336 exstrophy-epispadias complex patients was reviewed for complete primary repair of CBE cases referred to the authors’ institution, and those with injury to the penis were identified. The location, extent of injury, and subsequent management is reported. Triplanar magnetic resonance imaging (MRI) of the pelvis with volumetric analysis was used for penile compartment quantification.
Results : Of the 173 CBE patients referred after a prior complete primary repair, 25 (14%) were identified with penile loss. A majority (80%) were closed in the neonatal period, and 52% had a pelvic osteotomy. Ten patients (40%) had a failed primary closure. Median follow-up time was 9.8 years (range 3.3-21.3). Penile injury was often unilateral (72%), and involved the glans and/or corpora cavernosa. MRI of the pelvis confirmed anterior corporal deficiency that resulted from primary closure. Three patients were successfully managed with myocutaneous neophalloplasty between the ages of 15 and 16 years old.
Conclusions : As a part of the primary bladder closure, penile disassembly for epispadias repair may lead to penile ischemia. In addition to reconstructive planning, MRI may be used to quantify penile injury. CBE patients with penile injury can be managed with myocutaneous phalloplasty. Because of the soft tissue loss with complete penile disassembly, it may be time to reevaluate the application of this technique in the reconstruction of bladder exstrophy.