Document Detail


Penile ischemic injury in the exstrophy/epispadias spectrum: new insights and possible mechanisms.
MedLine Citation:
PMID:  20541473     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Partial or complete penile loss following bladder exstrophy and/or epispadias repair has been reported in the literature progressively more frequently.
PATIENTS AND METHODS: The authors report new cases of penile injury following bladder exstrophy and/or epispadias repair referred to their centers and not previously published. They review the literature on this subject and offer an explanation as to the likely mechanism for the penile injury and recommendations to avoid this complication.
RESULTS: Seven new cases of partial or complete penile loss following bladder exstrophy or epispadias repair have been recently referred to the authors' institutions. Twenty-one patients have previously been reported in the literature. Altogether, 24 cases occurred after bladder exstrophy closure: 23 after complete primary repair of exstrophy (Mitchell repair) and one after first-stage radical soft-tissue mobilization (Kelly repair). Nineteen of 24 patients did not have a pelvic osteotomy at the time of primary closure. Four cases occurred after epispadias repair: two following the second-stage radical soft-tissue mobilization (Kelly repair) and two following penile disassembly epispadias repair (Mitchell repair).
CONCLUSION: Exstrophy closure combined with epispadias repair can be followed by ischemic penile injury, particularly when osteotomy is not performed. Compression of the pudendal vessels after pubic apposition and/or direct injury to the pudendal vessels play an important role in the pathogenesis of this complication.
Authors:
Raimondo M Cervellione; Douglas A Husmann; Trinity J Bivalacqua; Paul D Sponseller; John P Gearhart
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Publication Detail:
Type:  Journal Article; Review     Date:  2010-06-11
Journal Detail:
Title:  Journal of pediatric urology     Volume:  6     ISSN:  1873-4898     ISO Abbreviation:  J Pediatr Urol     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-14     Completed Date:  2011-01-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101233150     Medline TA:  J Pediatr Urol     Country:  England    
Other Details:
Languages:  eng     Pagination:  450-6     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
Affiliation:
Division of Pediatric Urology, Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD, USA.
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MeSH Terms
Descriptor/Qualifier:
Animals
Bladder Exstrophy / surgery*
Epispadias / surgery*
Humans
Ischemia / etiology*,  physiopathology
Male
Osteotomy
Pelvic Bones / surgery
Penis / blood supply,  injuries*
Postoperative Complications / physiopathology
Soft Tissue Injuries / etiology
Urologic Surgical Procedures / adverse effects*,  methods
Comments/Corrections
Comment In:
J Pediatr Urol. 2010 Oct;6(5):457-8   [PMID:  20570566 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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