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Войти в исследования Journal of pediatric urology · 2025
Modified anatomical repair of epispadias (MARE)-with preservation of glans-frenular unit during urethral disassembly.
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Shajini Nirmalan, Babu Ramesh
Аннотация
BACKGROUND: In this video we report Modified Anatomical Repair of Epispadias (MARE)- where glans-frenular unit is preserved during urethral disassembly of Mitchell's technique.
METHODS/TECHNIQUE: The epispadiac urethra and spongiosa were completely dissected off the corporal bodies; distally the urethra was dissected off, but the attachment at the frenulum and prepuce to hemi-glans was retained. The neourethra was tubularised using 7-0 Polydiaxone (PDS) over an 8Fr silastic catheter; neo-metaus was fashioned in a ventral position in the glans. The corporal bodies were approximated dorsally ventralising the repaired neourethra. Glansplasty was done after glans sculpting to prevent glans cleft. Skin cover was provided by rotation of ventral penile skin.
RESULTS: Between 2000 and 2023, seven male epispadias patients; median age - 18 months (15-24 months) underwent MARE. All had penile epispadias without incontinence. Mean operative time was 180 min (150-210 min). There were no intraoperative/immediate post-operative complication or ischaemic glans loss. Median follow-up was 18 [12-36] months and there was no residual dorsal chordee/fistula. All had satisfactory cosmetic outcome.
CONCLUSION: This pilot study reports satisfactory outcomes of MARE where glans-frenular unit is preserved during urethral disassembly. It minimises glans loss by preserving blood supply between hemi-glans via the frenulum/ventral foreskin.
METHODS/TECHNIQUE: The epispadiac urethra and spongiosa were completely dissected off the corporal bodies; distally the urethra was dissected off, but the attachment at the frenulum and prepuce to hemi-glans was retained. The neourethra was tubularised using 7-0 Polydiaxone (PDS) over an 8Fr silastic catheter; neo-metaus was fashioned in a ventral position in the glans. The corporal bodies were approximated dorsally ventralising the repaired neourethra. Glansplasty was done after glans sculpting to prevent glans cleft. Skin cover was provided by rotation of ventral penile skin.
RESULTS: Between 2000 and 2023, seven male epispadias patients; median age - 18 months (15-24 months) underwent MARE. All had penile epispadias without incontinence. Mean operative time was 180 min (150-210 min). There were no intraoperative/immediate post-operative complication or ischaemic glans loss. Median follow-up was 18 [12-36] months and there was no residual dorsal chordee/fistula. All had satisfactory cosmetic outcome.
CONCLUSION: This pilot study reports satisfactory outcomes of MARE where glans-frenular unit is preserved during urethral disassembly. It minimises glans loss by preserving blood supply between hemi-glans via the frenulum/ventral foreskin.