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28
TH
CONGRESS OF THE ESPU
S7: EXSTROPHY-EPISPADIAS
COMPLEX
Moderators: Oriol Angerri (Spain), Ashraf Hafez (Egypt)
ESPU Meeting on Thursday 20, April 2017, 10:40–11:44
10:40–10:45
S7-1 (LO)
PRIMARY FEMALE EPISPADIAS : PERINEAL
URETHROCERVICOPLASTY OR KELLY REPAIR ?
Marc-David LECLAIR
1
, Sébastien FARAJ
1
, Thierry VILLEMAGNE
2
,
Guillaume LEVARD
2
, Emilie EYSSARTIER
3
, Marie BEY
3
and Philippe RAVASSE
3
1) Nantes University Children Hospital, Pediatric Urology, Nantes, FRANCE - 2) University Hospital, Pediatric Urology,
Tours, FRANCE - 3) University Hospital, Pediatric Surgery, Angers, FRANCE
PURPOSE
To report on the outcome of perineal urethro-cervicoplasty (PUCP) and radical soft-tissue mobilisa-
tion (Kelly repair, RTSM) in the surgical management of primary female epispadias tailored on
bladder status at diagnosis
MATERIAL AND METHODS
Prospective study of 14 consecutive girls (42months [12-102]) treated for incontinent primary
epispadias at a single institution (2006-2015), allocated to 2 groups according to bladder status:
- Group 1: Patients (n=7) with normal bladder cacapity (>80% of expected BC) and compliance at
preoperative assessment, treated with PUCP as a primary procedure.
- Group 2: Patients (n=7) with small/poorly compliant bladder, treated with primary RSTM and
cervicoplasty
Follow-up was based on annual functional assessment, renal ultrasound, uroflowmetry/residuals,
and cystomanometry whenever necessary. Continence score ranged from grade I (insuficient dry
intervals), grade II (dry by day), to grade III (dry day/night).
RESULTS
After a mean follow-up of 52 months [15-120], 12/14 girls showed acceptable social continence
grade II (n=5) or III (n=7).
Group 1 : after perineal approach, 5/7 acquired continence grade III. Three patients with insufficient
cervical resistances required bladder-neck injections (one of whom later underwent secondary
RTSM). None required CIC.
Group 2 : after Kelly repair, 6/7 patients developed grade II-III continence, with urodynamic evi-
dences of bladder catch-up growth. One girl with obstructive uroflows was under CIC.
CONCLUSIONS
Surgical strategy based on preoperative bladder status provides acceptable social dryness in the
majority of patients. Perineal urethrocervicoplasty, when applied to girls with adequate bladder,
offers dryness in most girls with minimal risks of passive obstruction, but may provide insufficient
resistances. In children with small bladder, the Kelly operation seems to trigger bladder growth and
subsequent dryness intervals.