The main goal of treatment is to make the genitals look and work as normally as possible. This is ideally done with the fewest number of surgeries.
Surgery Options for Boys
The main goals of epispadias treatment for boys are to:
- Make sure the penis works
- Fix bends in the penis (dorsal bend and chordee)
- Make the penis a good length
- Make the penis look normal
If the bladder and bladder neck are affected, surgery will be needed to make sure the child can control his urine. Surgery might also be needed to preserve fertility.
There are two popular types of surgery. Both provide a normal-looking penis that works properly. The surgery is often done while the child is a baby. The type chosen depends on:
- The type of epispadias
- Surgeon experience
- Surgeon preference
Sometimes, boys with the exstrophy-epispadias complex are born with a very underdeveloped penis. In these cases, surgery requires more skill and experience. You may ask your urologist for the name of a specialist.
The Modified Cantwell Technique
The modified Cantwell technique involves "rebuilding" the penis. It takes some of the penis apart to move the urethra to a more normal position.
The Mitchell Technique
The Mitchell technique involves taking the penis apart completely, then putting it back together. This is done so the urethra is in the most functional and normal position, and dorsal bend (chordee) is corrected.
Surgery Options for Girls
Reconstruction in girls is less complex than in boys. The urethra and vagina may be short and near the front of the body. The clitoris may be in 2 parts. The internal female structures – uterus, fallopian tubes, and ovaries – are usually normal.
If diagnosed at birth, the 2 parts of the clitoris can be brought together and the urethra can be placed in the normal position. If repaired early enough, lack of urinary control (incontinence) may not be a problem.
If the problem isn't diagnosed early or early repair isn't done, then incontinence can be surgically corrected when it's discovered. If the vaginal opening is narrow in older girls or younger women, reconstruction can be done after puberty.
With the newer methods of surgical repair at birth, almost 1 in 3 children achieve urinary control without other procedures. Children with the exstrophy-epispadias complex may need additional surgery to repair the bladder neck. This is done to improve the strength of the urethra and sphincter. Or, if a child can't toilet train normally, there are more options.
One way is to inject a bulking material around the bladder neck. This makes the bladder neck thicker so urine can't leak out.
There are also more complex procedures. One surgery creates a longer urethral tube. Another involves wrapping the bladder neck with a sling.