COMPLETE PENILE DISASSEMBLY FOR ISOLATED EPISPADIAS REPAIR WITH MITCHELL-CAIONE TECHNIQUE: TWO CASES

Isolated male epispadias defect is present in 10% of cases of epispadias-exstrophy complex. Many surgical technique have been described for repair of male epispadias. The aim of surgical repair is to get cosmetically acceptable and functional penis with a ventrally located urethra opening at the tip of the glans and moreover to give the patient a urinary continence. Surgical repair of epispadias malformation remains debatable as evident by the different techniques adopted. We present two cases of our experience where we used the complete penile disassembly tecnique by Mitchell-Caione in wich we acts on the voluntary control of urination by the reapproximation of the muscular plane of pelvic diaphragm and elevator muscle around the posterior urethra reconstructed. Epispadias repairs was performed on two incontinent male epispadias patient, aged 2 to 3 years. Both cases were untreated. Complete disassembly of penil components was performed to the corporal attachments down to the horizontal branches of pubic bones. The corporal bodies and the glans were split on the sagittal plane according to Grady-Mitchell. The central portion of the urethral plate was preserved intact. An electric stimulator was used to identify and reapproximate at the midline the muscular fibers that constitute the periurethral muscular complex, as a part of the anterior perineal membrane. “Z plasties” were necessary according to initial urethral length and width: the urethra was reconstructed over a double catheters, using 5/0 polyglicolic acid interrupted sutures in a single layer. In one patient we sutured symphisis pubis opened precedently, using 1/0 polyglicolic acid. The urethra was placed ventrally in the reconstructed shaft under the two corpora as Mitchell technique. Glanduloplasty was then performed. Patients were followed up for one month (June 2012). The penis of the two patients had a satisfactory cosmetic appearance with no dorsal chordee. Morover, our patients obtained urinary continence. The limitation of our study was the low follow-up. The electric stimulator used to identify pelvic muscle components in the sagittal plane for reapproximate the posterior tabularized urethra to form the periurethral muscle complex and the “Z-plasties” that elongated the urethra significantly.This procedure seems to be satisfactory for the repair of cases of isolated male epispadias because we have good results in cosmetic appearance and in urinary continence. Our study is a preliminary report and a longer follow-up with a larger number of cases is needed to document further the success of the procedure.