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Penile reconstruction, including lengthening and urethroplasty, was successful in 80.6% of men who had undergone bladder exstrophy (BE) surgery during infancy, indicating the potential need for reconstructive interventions in those experiencing penile dissatisfaction.
The following is a summary of “Penile reconstruction after complete bladder exstrophy repair,” published in the January 2024 issue of Pediatrics by Hammouda et al.
In this investigation, the study group addressed the issue of decreased penile length in adults born with bladder exstrophy (BE), attributing it to factors such as pubic symphysis diastasis, corporal body separation, anterior corporal compartment shortening, residual dorsal penile curvature, and postsurgical scar formation. Their study aimed to assess the necessity and efficacy of penile reconstruction in adult men who had undergone BE surgery during infancy. The records of 31 repaired BE patients, with a mean age of 21.4 ± 3.7 years, were scrutinized. These patients expressed dissatisfaction with short penile length, residual dorsal penile curvature, distal dorsal or hypospadias urethral opening, and scarred penopubic skin. Penile lengthening, involving sub-periosteal detachment of corporal bodies from pubic rami, was performed in all cases, with full-thickness dermal grafts used in 8 patients for penile resurfacing.
Additionally, 12 patients underwent coronal or glandular urethroplasty, and one underwent phalloplasty using a forearm-free graft. Subjective patient evaluations reported satisfactory results in 25 out of 31 cases (80.6%). The degree of penile lengthening, assessed at 6 months and one year postoperatively, demonstrated an increased length ranging from 50% to 150% of the preoperative penile length. Their discussion postulates that both congenital and iatrogenic factors contribute to multifaceted causes of penile shortening in adult males with BE. The researchers suggest that penile lengthening is viable, contingent upon careful and partial mobilization of the crura from the pubic rami.
In conclusion, their findings indicate the successful correction of the short phallus, residual dorsal chordee, and distal urethroplasty in most patients with BE. This underscores the potential need for an additional reconstructive stage in adult males with BE experiencing penile dissatisfaction.
Source: sciencedirect.com/science/article/abs/pii/S1477513124000196
