Bucca Bruno, Stojanovic Borko, Bizic Marta, Bencic Marko, Pušica Slavica, Djordjevic Miroslav
Department of Maternal Childhood and Urological Sciences, Sapienza Rome University, 00185 Rome, Italy.
Belgrade Center for Genitourinary Reconstructive Surgery, 11000 Belgrade, Serbia.
Int Braz J Urol. 2025 Nov-Dec;51(6). doi: 10.1590/S1677-5538.IBJU.2025.0171.
Surgical treatment of epispadias has evolved significantly, from early tubularization techniques to modern penile disassembly approaches (1-3). Despite advancements, achieving urinary continence remains challenging and typically requiring multiple interventions (4).
The objective is to present complete penile disassembly (Belgrade) technique for primary epispadias repair.
We present a case of isolated penopubic epispadias and severe dorsal curvature in 18-month-old boy. Meticulous dissection is conducted ventrally and dorsally to isolate the urethral plate and spongiosal tissues. The Buck's fascia is incised ventrally to isolate the neurovascular bundles, followed by complete separation of the corpora cavernosa from each other and from the glans. The urethral plate is dissected free, transposed ventrally, and tubularized over a catheter. Penile straightening and lengthening are achieved through internal rotation of the corpora cavernosa and dorsal corporotomy with skin grafting. Glans reconstruction is done. Reassemble of all entities is performed, followed by penile skin reconstruction.
At the three-month follow-up, the patient demonstrated satisfactory voiding with a good urinary stream, without evidence of urethral fistula or stricture. The cosmetic outcome was favorable, with no signs of recurrent curvature. The patient remains under vacuum device therapy, till 12 month after sugery.
The Belgrade approach for isolated penopubic epispadias includes radical approach with complete disassembly. This one-stage repair enables correction of all deformities - penile lengthening and strengthening, urethroplasty, glansplasty and penile skin reconstruction, with good outcomes.
尿道上裂的外科治疗已取得显著进展，从早期的管状化技术发展到现代的阴茎解体术（1-3）。尽管有这些进展，但实现尿失禁仍然具有挑战性，通常需要多次干预（4）。
目的是介绍用于原发性尿道上裂修复的完全阴茎解体（贝尔格莱德）技术。
我们报告一例18个月大男孩的孤立性耻骨前尿道上裂和严重阴茎背曲病例。在腹侧和背侧进行细致解剖，以分离尿道板和海绵体组织。在腹侧切开巴克筋膜以分离神经血管束，随后将海绵体彼此以及与龟头完全分离。游离尿道板，将其向腹侧移位，并在导尿管上进行管状化。通过海绵体的内旋和背侧海绵体切开术及植皮实现阴茎伸直和延长。进行龟头重建。重新组装所有结构，随后进行阴茎皮肤重建。
在三个月的随访中，患者排尿情况令人满意，尿流良好，无尿道瘘或狭窄迹象。美容效果良好，无复发弯曲迹象。患者仍在接受真空装置治疗，直至术后12个月。
贝尔格莱德方法用于孤立性耻骨前尿道上裂包括彻底的完全解体方法。这种一期修复能够矫正所有畸形——阴茎延长和加固、尿道成形术、龟头成形术和阴茎皮肤重建，效果良好。
