Male Genital Reconstruction in the Exstrophy-Epispadias Complex
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MALE AND FEMALE SURGICAL INTERVENTIONS (C CARSON AND P SELPH, SECTION EDITORS)
Male Genital Reconstruction in the Exstrophy-Epispadias Complex Thomas H. Reid 1 & Wai Gin Lee 1 & A. Nim Christopher 1,2 & David J. Ralph 1,2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Adult males with exstrophy-epispadias complex (EEC) are commonly dissatisfied with their genitalia and desire greater sexual normality. These patients have typically had several previous genital/pelvic procedures and there are specific considerations that must be taken into account if operative intervention is being considered. Genital reconstruction in the form of phalloplasty presents an option for improving sexual function. Recent Findings The majority of studies have focused on the radial free forearm flap (RFFF) phalloplasty with subsequent insertion of penile prosthesis (PP). Long-term cosmetic and functional satisfaction is high. Early urethral complications are common and PP-related complications are higher than in other patient populations. Summary Genital reconstruction is a safe procedure for EEC males with good long-term functional and cosmetic satisfaction. RFFF phalloplasty represents the most complete surgical option and should be considered in carefully selected patients. Keywords Exstrophy-epispadias complex . Genital reconstruction . Phalloplasty . Penile prosthesis
Introduction
Exstrophy-Epispadias Complex
The exstrophy-epispadias complex (EEC) describes a range of congenital genitourinary malformations of varying severity. The complex may result in significant impairment of the urinary and sexual function of the patient. A significant number will seek genital reconstruction (GR) upon reaching adulthood. This already challenging surgical endeavour is further complicated by the history of neonatal reconstruction and should be undertaken at a large-volume centre with the requisite expertise. The aim of this article is to provide an understanding of the surgical anatomy and options for reconstruction in this challenging group of patients.
The EEC spectrum ranges from epispadias at its least severe to bladder and cloacal exstrophy at its most severe. The incidence is reported as 1 in 10,000 live births [1] and cases are primarily sporadic [2]. Bladder exstrophy (BE) has an estimated prevalence of 2.07 per 100,000 births with males being almost twice as likely to be affected as females [3]. The embryological basis of EEC is poorly understood but is thought to relate to anomalous growth or premature rupture of the cloacal membrane that manifests as midline abdominal defects [4–6]. In classical BE the internal surface of the bladder is externalised and fused to the anterior abdominal wall with the urethral plate on the dorsal penile surface (epispadias) rather than on the normal ventral surface. The pubic symphysis is widely separated.
This article is part of the Topical Collection on Male and Female Surgical Interventions * Thomas H. Reid [email protected] 1
University Co
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