Mollard P, Basset T, Mure P Y
Hôpital Debrousse, Chirurgie Pédiatrique, Lyon, France.
J Urol. 1998 Jul;160(1):55-9. doi: 10.1016/s0022-5347(01)63027-1.
We evaluate the long-term results of surgery for isolated (without exstrophy) male epispadias.
A total of 45 male patients with isolated epispadias were treated and followed at Debrousse Hospital between 1971 and 1993, 8 in whom repairs performed elsewhere had failed and 14 had total urinary incontinence. Incontinence was treated with a modified Young-Dees reconstruction of the bladder neck and the ureters were reimplanted in all cases. Long-term followup was available in 18 cases of a Cantwell-Young-Gross, 4 Duplay, 7 full thickness skin graft, 1 bladder graft and 10 Cantwell-Ransley urethroplasties. Penile reconstruction was performed using a 2-stage procedure in 8 patients (freeing of the corpora followed by urethroplasty), and an isolated urethroplasty in 13. All other patients underwent a single stage repair combining dissection of the penis and urethroplasty.
All patients were reassessed clinically. Of 13 incontinent patients followed for 1 to 20 years 11 acquired continence, 1 remains incontinent and 1 underwent a repeat procedure recently. Urethroplasty was immediately satisfactory in 66% of the cases, minor complications developed in 25% and serious complications (especially free graft urethroplasty) developed in 10%. Assessment of genital cosmesis is subjective but it was considered acceptable in most cases. All 29 patients with long-term followup had erections, 24 performed regular sexual intercourse, 17 had normal ejaculations and 4 fathered children.
The principles described by Cantwell-Young and Gross, and modified by Ransley, have considerably improved penile reconstruction. Free graft and Duplay urethroplasties provided unacceptable results in our series. Our results of surgery for incontinence associated with isolated male epispadias (84%) were better than for male exstrophy (63%).
我们评估孤立性（无膀胱外翻）男性尿道上裂手术的长期效果。
1971年至1993年间，共有45例孤立性尿道上裂男性患者在德布鲁斯医院接受治疗并随访，其中8例在其他地方进行的修复手术失败，14例存在完全性尿失禁。尿失禁采用改良的Young-Dees膀胱颈重建术治疗，所有病例均进行输尿管再植术。对18例Cantwell-Young-Gross术式、4例Duplay术式、7例全厚皮片移植术、1例膀胱移植术和10例Cantwell-Ransley尿道成形术进行了长期随访。8例患者采用两阶段手术进行阴茎重建（游离阴茎海绵体后行尿道成形术），13例采用单纯尿道成形术。所有其他患者均接受一期修复，包括阴茎解剖和尿道成形术。
对所有患者进行了临床重新评估。13例尿失禁患者随访1至20年，11例获得控尿，1例仍失禁，1例最近接受了再次手术。66%的病例尿道成形术即刻效果满意，25%出现轻微并发症，10%出现严重并发症（尤其是游离皮片尿道成形术）。生殖器美观评估是主观的，但大多数情况下认为可以接受。所有29例接受长期随访的患者均有勃起功能，24例有规律的性生活，17例射精正常，4例育有子女。
Cantwell-Young和Gross描述并经Ransley改良的原则显著改善了阴茎重建。在我们的系列研究中，游离皮片和Duplay尿道成形术效果不佳。我们对孤立性男性尿道上裂相关尿失禁的手术治疗效果（84%）优于男性膀胱外翻（63%）。
