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Is bladder neck reconstruction routinely needed to achieve urinary continence in patients with primary epispadias?
Arianna Mariotto, MD, David J. Keene, MD, Abdul Alshafei, MD, Almutairi Faisal, MD, Jennifer Powell, CNS, Tamas Cserni, PhD, Raimondo M. Cervellione, PhD.
Manchester University NHS Fundation Trust, Manchester, United Kingdom.

BACKGROUND This study aims to investigate the continence outcome for male and female primary epispadias patients treated at the authors' institution, focusing on the need of additional continence procedures following the initial primary epispadias repair to achieve dryness.
METHODS Patients born with primary epispadias treated between 2007 and 2019 and already potty trained were identified from a prospective maintained database. Males underwent partial penile disassembly, rotation of the corpora, urethroplasty and glanuloplasty. Females underwent genitoplasty with reduction urethroplasty. The following outcomes were measured: type of epispadias, age at the time of primary epispadias repair, need of pelvic floor muscles (PFM) biofeedback therapy, need of further continence surgery, age at follow-up, urinary continence, presence of hydronephrosis at follow-up. Data is presented as median.
RESULTS Thirty patient (27 males) were included. Of the males, 9 had penopubic epispadias, 15 had glanular epispadias and 3 had duplicated urethra. Median age at the time of primary epispadias was 2 years (1-3) and at follow-up was 8 years (6-10). Overall, 67% demonstrated daytime urinary continence with volitional voiding, 23% required pads during daytime and 10% were incontinent. PFM biofeedback therapy was performed in 43% after the age of 4 years. None has yet undergone additional surgical continence procedures and none had hydronephrosis at follow up.
CONCLUSIONS Most children with primary epispadias can achieve social urinary continence spontaneously or with the support of PFM biofeedback therapy. Additional surgical procedures should be considered only for patients who have not achieved continence after potty training and PFM biofeedback therapy.

CATEGORYPENOPUBICPENILE/GLANULARDUPLICATED URETHRAFEMALETOTAL
NUMBER OF PATIENTS9153330
AGE AT SURGERY (yrs)1.6 (1.1-2.3)2.3 (1.6-3.2)5.4 (3.7-6.9)4.6 (2.7-5.9)2.0 (1.3-3.6)
AGE AT FOLLOW UP (yrs)7.0 (4.9-8.3)7.7 (4.5-8.9)12.4 (8.6-13.4)9.8 (9.6-11.5)8.6 (6.1-10.9)
PFM BIOFEEDBACK THERAPY7 (78%)2 (13%)1 (33%)3 (100%)13 (43%)
DRY - DAY3 (33%)14 (93%)2 (67%)1 (33%)20 (67%)
PADS - DAY5 (56%)0 (0%)1 (33%)1 (33%)7 (23%)
WET - DAY1 (11%)1 (7%)0 (0%)1 (33%)3 (10%)
DRY AT NIGHT4 (44%)12 (80%)2 (67%)0 (0%)18 (60%)
WET AT NIGHT5 (56%)3 (20%)1 (33%)3 (100%)12 (40%)


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