Epispadias in a Child with Intact Prepuce: A Rare Congenital Abnormality

Epispadias is a rare genitourinary malformation, more so is epispadias with intact prepuce. Incidence of epispadias with intact prepuce is not known however, there are few case reports and a case series. We present a 5-year-old boy brought to our facility by his parent for circumcision. Further evaluation revealed a short penis with broad base and intact prepuce. The preputial slit was dorsally oriented. On retracting the prepuce, there was corona epispadias with wide and healthy urethral plate. No meatal stenosis or chordee noticed. Other findings were normal. He had epispadias repair. The postoperative period was uneventful. Three months after operation, the prepuce was easily retractable over the penis and the penis was cosmetically acceptable.

Epispadias:recent techniques

Aim:This paper presents the latest surgical approaches for epispadias treatment in the pediatric population,as well as those for adolescent and adult populations after initial failed repair in childhood.Methods:The retrospective study was conducted between March 2005 and May 2020 and included 18 patients with the mean age of 21 months(range 11-48 months)(Group A),who underwent primary epispadias repair and 15 patients with the mean age of 18 years(range 13-29 years)(Group B),who underwent redo surgery after failed epispadias repair in childhood.In Group A,the surgery was performed as a one-stage procedure using complete penile disassembly technique,while,in Group B,the surgery was done as a two-stage procedure and included complete straightening and lengthening of the penis,followed by urethral reconstruction.Penile straightening and lengthening were achieved by tunica albuginea incision and grafting.In Group A,the urethral plate was mobilized,transposed ventrally,and tubularized and augmented with vascularized preputial skin flap where needed.In Group B,the urethra was reconstructed either using the buccal mucosa graft and genital skin flaps or with tubularization of genital skin flaps.Successful treatment was defined as a functional and esthetically acceptable penis without complications.Results:The mean follow-up was 88 months(range 15-197 months).Satisfactory results were achieved in 26/33 patients.Urethral fistula occurred in 4/18 patients from Group A and in 3/15 patients in Group B and was surgically repaired after four months.Skin dehiscence occurred in eight patients,five from Group A and three from Group B.Recurrent penile curvature was observed in 2/18 patients from Group A and required surgical correction and in 2/15 patients from Group B and was mild and did not need surgical repair.Eleven patients from Group B who filled out the International Index for Erectile Function reported satisfying erectile function,sexual desire,intercourse,and overall satisfaction.Conclusion:Primary or redo epispadias repair is challenging even for experienced reconstructive urologists.Only radical surgical approach can lead to complete correction of all deformities and provide successful outcome.

Complete Urethral Duplicity: A Rare Cause of Urinary Incontinence, New Type According to Effman’s Classification

Aim: To describe the clinical, anatomical, therapeutic aspects and propose a diagram of a new type of a complete urethral duplicity in classification of Effman. Material and Methods: This was a case report of a 14-year-old patient who suffered from birth of incontinence occurring while sitting with concept of preservation of normal urination. The patient was carrying two urethral meatus, one continent and the other incontinent. The two urethral meatus were easy to catheterize. The imagery was non-contributory. Resection of accessory urethra helped to make the patient continent. Informed consent was obtained from the patient’s parents for the surgical management, the anonymous use of record and photographs for scientific aims. Results: The diagnosis of urethral duplicity was retained. An explanatory approach is reported, a new scheme is proposed to improve the classification of Effman. Conclusion: The urethral duplicity is a rare urogenital abnormality whose etiology and pathophysiology are not fully understood and has not finished delivering the secret of his classification.