Management of the exstrophy-epispadias complex in adolescents and adults

Objectives: To study the presentation and management of the exstrophy-epispadias complex in adolescents and adults and to evaluate the outcome of the repair. Subjects and methods: This retrospective review of our medical records of adult patients with an exstrophy-epispadias complex managed between January 2010 and June 2015 included one female and 7 male patients. Only patients aged above 10 years who had not undergone any surgical treatment during childhood were included in the study. All patients were subjected to preoperative biopsy from the urinary bladder plate. None of them underwent cystectomy. Seven patients underwent urinary bladder augmentation using ileocystoplasty, bladder neck reconstruction with para-urethral tissue closure using a wedge of pubic bone, and single-stage epispadias repair. In one patient epispadias repair was not done due to intraoperative hemodynamic instability. Results: All patients are continent but one in whom epispadias repair was not done and who is waiting for epispadias repair. One patient has developed a urethro-cutaneous fistula at the base of the penis. Two patients developed urinary bladder stones, and both of them were managed by minimally invasive methods. All the patients are on clean intermittent self-catheterization. They are all doing well socially and psychologically. Conclusion: Though exstrophy-epispadias in adolescents and adults is a rare entity, the described modified surgical technique provides good results and improves the patients’ social and psychological well being.