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INTRODUCTION AND OBJECTIVES: Isolated female epispadias without bladder exstrophy is a rare urogenital anomaly. Refractory urinary incontinence and bifid clitoris or exposed bladder neck (BN) is the usual presentation. There are few published reports regarding post-operative urinary continence following BN repairs. Herein we compare surgical outcomes following two techniques: perineal cervicoplasty with BN tailoring (PC+BNT), a simplified repair, versus classic Young-Dees-Leadbetter (YDL) BN repair.

METHODS: We retrospectively reviewed 14 patients with isolated female epispadias managed between 2001 and 2013, divided in two groups: PC+BNT and classic YDL . For the PC + BNT group the BN was tailored using a simplified perineal approach, incising the inter-symphiseal bands to improve visualization. For YDL, the BN the trigone were tubularized as previously described, using an infra-umbilical incision. In both groups clitoroplasty and vulvoplasty were performed.

RESULTS: Nine cases were diagnosed at birth. All cases had bifid clitoris. Pubic diastasis was present in 7/12 (58%) cases. The median age for PC +BNT and YDL was 9 years (8-16) and 10 years (1-17), respectively. None required concurrent osteotomies. Bladder augmentation was done at the time of the first procedure in 2/3 patients from the YDL group. Table 1 presents continence outcomes for both surgical techniques. For older children, following the initial procedure, the continence rate was 71% (5/7) in PC +BNT vs. none in YDL. Deflux injection was done in 3 incontinent patients after PC + BNT rendering 2 continent and one remains with stress incontinence. In YDL group, redo BN repair with appendicovesicostomy (2/3 patients) was successful rendering them all dry on CIC. Most patients have volitional voiding after PC +BNT although 2 are still young to evaluate toilet training but they seem to cycle their bladders with dry intervals. All patients had good cosmetic results.

CONCLUSIONS: Female epispadias can be successfully repaired using a simplified perineal approach. Ultimately most patients achieve continence with either technique although volitional voiding was achieved only with PC + BNT. Our preliminary findings indicate better outcomes with PC+ BNT but long-term follow up as well as other centers experience is needed to confirm our results.

Source of Funding: None