Comparison of internal and external rotation of corpora cavernosa in classic bladder exstrophy: A quantitative analysis of urethral coverage.

OBJECTIVE

In classic bladder exstrophy (CBE), achieving optimal urethral coverage during epispadias repair (ER) remains surgically demanding. This study introduces a novel anatomical maneuver-external rotation (ExR) of the corpora cavernosa (CC)-and quantitatively compares it to internal rotation (InR) to determine which provides superior urethral coverage and penile length.

MATERIALS AND

METHODS

We retrospectively analyzed 29 patients (aged 11-59 months) who underwent primary ER between 2020 and 2024 after prior bladder closure. In each case, the CC were fully mobilized, and neurovascular bundles were dissected to allow both InR and ExR. Each patient served as their own control. Urethral coverage and penile length were measured following both rotational techniques.

RESULTS

ExR significantly improved urethral coverage compared to InR (mean difference: 9.79 mm; p < 0.0001). Urethral coverage gain correlated positively with patient age (rho = 0.6182, p = 0.0004), suggesting greater benefit in older children. All patients demonstrated an increase in coverage after ExR. A positive correlation was observed between age and the magnitude of coverage increase, although CC length was not directly measured. Two urethrocutaneous fistulas (6.9 %) occurred; one resolved after catheterization and one required surgical revision.

CONCLUSIONS

ExR of the corpora cavernosa is a simple yet effective modification that offers greater urethral coverage in ER for CBE. These findings support its use-particularly in patients with an adequate urethral plate-as a preferable alternative to the traditional InR approach. Further studies with long-term outcomes are recommended.