Long-term follow-up after traditional versus modified perineal approach in the management of female epispadias. Issue 5 (October 2017) - Alyami, F.
Summary: Objective: Isolated female epispadias (IFE) is a rare congenital anomaly. The defect extends to the bladder neck, which is usually incompetent. The traditional surgical approach includes urethral and genital reconstruction in the first year, followed by bladder neck reconstruction (Young-Dees-Leadbetter cervicoplasty (YDL)) at the age of social continence. An alternative single-stage technique includes urethral, bladder neck and clitoris repair by a perineal approach. The aim of the present study was to describe long-term follow-up of patients who underwent the traditional vs alternative approach. Materials and methods: A retrospective review was performed of all female epispadias cases managed between 2000 and 2013. The YDL procedure (Group 1) vs single-stage perineal approach (Group 2) cases were followed and compared. Collected variables included: patients' demographics, age at diagnosis and surgery, presence of associated anomalies, clinical presentation, presence of vesicoureteral reflux (VUR), and pre-operative and postoperative continence. Results: A total of 12 cases of female epispadias were managed and followed between 2000 and 2013. No major complications occurred in either group. Urinary continence evaluated in seven children showed that none (0/3) and 4/7 (57%) were continent following the initial procedure in Group 1 and Group 2, respectively. All patients in Group 1 failed to achieve continence and required re-intervention. Conclusions: Female epispadias could be successfully repaired using a single-stage modified perineal approach that achieved good continence with volitional voiding, good cosmetic results and compared favorably with the ones repaired with the YDL technique. The additional step of performing bladder neck tailoring to achieve a funneling configuration seemed to be useful in improving continence. Table Long-term outcomes for urinary continence for the YDL and single-stage perineal approach. Age at 1st surgery Postoperative continence Need for redo-surgery Further procedures for incontinence Need for bladder augmentation Age at last follow-up Continence post redo-surgery YDL BNR (Group 1) 1 4 Wet Yes BNR (Mitchell), appendicovesicostomy Yes 8 Dry with CIC 2 4 Wet Yes BNR YDL, appendicovesicostomy Yes 15 Dry on CIC 3 4 Wet Yes Bladder neck Deflux ® injection No 14 Dry on CIC Single-stage perineal approach (Group 2) 1 13 Dry No N/A No 16 Dry 2 17 Dry No N/A No 18 Dry 3 1 Not toilet trained No N/A No 2.5 N/A 4 1 Not toilet trained No N/A No 2.5 N/A 5 1.5 Dry No N/A No 8 Dry 6 2 Dry No No No 1 Dry 7 1.2 Stress Incontinence Yes Bladder neck Deflux ® injection No 8 Dry 8 5 Stress/urge Incontinence Yes Bladder neck Deflux ® injection No 15 Dry 9 5 Stress/urge Incontinence Yes Bladder neck Deflux ® injection No 10 Stress/urge incontinence BNR, bladder neck reconstruction; YDL, Young-Dees-Leadbetter cervicoplasty.