Journal of pediatric urology · 2026
Pubic diastasis as a predictor of continence outcomes in the isolated male epispadias patient: An innovative prognostic factor.
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Heap David, Simpkins Alex, Yang Jason, Mayeux Erin, Radaoui Alex, Robey Catherine, Hirsch Alex, Di Carlo Heather, Gearhart John P, Crigger Chad B
Аннотация
INTRODUCTION/OBJECTIVES: Isolated male epispadias (IME) presents as an abnormally displaced dorsal opening of the urethral meatus. It occurs in 1:120,000 live male births. Like all pathologies within the Bladder Exstrophy-Epispadias Complex (BEEC), this condition is associated with varying degrees of a widened pubic diastasis. This study sought to investigate the correlation between width of diastasis and continence outcomes.
METHODS: An IRB-approved, prospectively maintained, single-institutional BEEC database was utilized to identify male patients with isolated epispadias. Electronic medical records were reviewed for data pertaining to patient demographics, their original epispadias revision surgeries, and continence procedures and outcomes. Width of pubic diastasis was recorded through measurements obtained in radiographic imaging. Continence was described in terms of social continence or >3 h of daytime dry intervals between voids. These factors were assessed for their impact on continence outcomes.
RESULTS: Of the 144 male epispadias cases reported in the database, 61 patients with complete data were identified. Of the 61 patients, 31 (51 %) achieved social continence while the remainder are incontinent. Mean width of pubic diastasis was relatively shorter in the continent group (2.00 cm, SD 1.18 cm vs 2.54 cm, SD 1.02 cm) when compared to the incontinent cohort (p = 0.0606). 15 of 31 continent patients did not require additional surgery to achieve continence while the remainder received 1-3 surgeries to achieve dryness. The 16 that required surgery had a significantly wider pubic diastasis (2.8 cm, SD 0.98 vs 1.17 cm, SD 0.69 cm) when compared to the nonsurgical group (p < 0.001). Of the 30 incontinent patients, 22 of them have not received additional continence surgery while 8 have had 1-2 surgeries. There was no significant difference (p = 0,0724) in diastasis width between those who received surgery and those who did not (2.54, SD 0.71 cm vs 2.54, SD 1.13 cm).
CONCLUSION: This is the first study to investigate the relationship between pubic diastasis with continence outcomes and suggest that width of pubic diastasis can play a role in the surgical management of achieving continence in the IME population. These findings can assist in clinical decision making when considering the need for continence surgery in these patients, while also helping to manage patient and parent expectations.
METHODS: An IRB-approved, prospectively maintained, single-institutional BEEC database was utilized to identify male patients with isolated epispadias. Electronic medical records were reviewed for data pertaining to patient demographics, their original epispadias revision surgeries, and continence procedures and outcomes. Width of pubic diastasis was recorded through measurements obtained in radiographic imaging. Continence was described in terms of social continence or >3 h of daytime dry intervals between voids. These factors were assessed for their impact on continence outcomes.
RESULTS: Of the 144 male epispadias cases reported in the database, 61 patients with complete data were identified. Of the 61 patients, 31 (51 %) achieved social continence while the remainder are incontinent. Mean width of pubic diastasis was relatively shorter in the continent group (2.00 cm, SD 1.18 cm vs 2.54 cm, SD 1.02 cm) when compared to the incontinent cohort (p = 0.0606). 15 of 31 continent patients did not require additional surgery to achieve continence while the remainder received 1-3 surgeries to achieve dryness. The 16 that required surgery had a significantly wider pubic diastasis (2.8 cm, SD 0.98 vs 1.17 cm, SD 0.69 cm) when compared to the nonsurgical group (p < 0.001). Of the 30 incontinent patients, 22 of them have not received additional continence surgery while 8 have had 1-2 surgeries. There was no significant difference (p = 0,0724) in diastasis width between those who received surgery and those who did not (2.54, SD 0.71 cm vs 2.54, SD 1.13 cm).
CONCLUSION: This is the first study to investigate the relationship between pubic diastasis with continence outcomes and suggest that width of pubic diastasis can play a role in the surgical management of achieving continence in the IME population. These findings can assist in clinical decision making when considering the need for continence surgery in these patients, while also helping to manage patient and parent expectations.