Single-stage subsymphyseal cystoscopic-guided bladder neck plication and urethrogenitoplasty in female epispadias: presentation of long-term follow-up.

Objective: • To investigate the feasibility of an endoscopic technique as a guide to evaluate bladder outlet resistance during bladder neck plication (BNP) for treatment of female epispadias.

Patients And Methods: • The postoperative outcomes with long-term follow-up of 10 girls with epispadias were reviewed (four had a previous history of bulking agent injection into the BN). • After taking a skin flap from the area between the crura of the bifid clitoris, subsymphyseal dissection was continued to the BN. • Under cystoscopic guidance, BNP was performed using absorbable sutures (two cases) or non-absorbable sutures (eight) aiming to attain a smooth closure of the BN during gradual withdrawal of the cystoscope. • Finally, urethrogenitoplasty was accomplished by urethral reconstruction with tubularization of the inter-clitorial flap followed by monsplasty and approximation of the two hemi-clitorises.

Results: • The mean (range) follow-up was 9.1 (5-15) years. • After primary surgery seven of the 10 girls were continent and all could void normally. • Of the three failed cases (including two that underwent BNP using absorbable suture), two became dry after injection of bulking agent into the BN and the remaining girl underwent BN reconstruction; she was socially continent at the final follow-up. • Ultimately, all 10 girls were socially continent, including six who were completely dry. • Urodynamic studies showed an increase in mean bladder capacity (P < 0.001) and a significant time-dependent improvement of the leak-point pressure and maximum urinary flow rate.

Conclusions: • The present series suggests that single-stage subsymphyseal urethrogenitoplasty together with cystoscopic-guided BNP for management of female epispadias is reliable and effective with definite advantages. • The high success rate and safety of the procedure are important factors for the introduction of this method as a valid option for treatment of this rare congenital anomaly.