WOFAPS 2025 8th World Congress of Pediatric Surgery

Hammou Benslimane, Fatema Hadjou Belaid

faculté de médecine d'Oran Algérie

Purpose:In classic bladder exstrophy or epispadias, the penis is typically flattened and curved (recurvatum), with a flattened glans and a ventral preputial hood. Although the corpora cavernosa are of normal caliber, pubic diastasis results in a shortened penile shaft. Peno-pubic adhesions and tethering of the urethral plate further contribute to ventral curvature.Materials and Methods:Between 2015 and 2022, 30 boys underwent primary reconstruction using the modified Cantwell-Ransley technique: 20 with bladder exstrophy and 10 with isolated epispadias. The procedure involved extensive mobilization of the urethral plate from the corpora cavernosa, preserving its mesentery attached to the ventral penoscrotal skin. The corpora were lengthened by dividing the suspensory ligaments at the pubic insertion. Urethral and glanular tubularization, ventral curvature correction, and penile skin coverage completed the reconstruction.Results:The mean follow-up duration was 24 months (range: 10–38 months). Urethrocutaneous fistulas developed in 5 patients following epispadias repair. One resolved spontaneously within six weeks; the remaining four required surgical revision. Two fistulas were located at the penile base. No cases of skin dehiscence were reported. Penile angulation in the standing position was either horizontal or downward in all patients. Cosmetic outcomes were deemed satisfactory by both parents and patients. All children urinated through the orthotopically reconstructed urethra.Conclusion:The modified Cantwell-Ransley technique is effective for the reconstruction of penile and penopubic epispadias, as well as for residual epispadias in bladder exstrophy patients. It facilitates correction of dorsal curvature, yields a fistula-free ventral urethra, and results in a well-aligned, aesthetically acceptable penis.