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Diagnosis and management of epispadias.

Epispadias is a rare diagnosis and most commonly described as a part of the bladder exstrophy complex. Epispadias is characterized by failure of the urethral plate to tubularize on the dorsum with the defect ranging from a glandular to a penopubic location. In addition, male patients demonstrate a dorsal chordee whereas female patients exhibit a bifid clitoris. The goal of surgical correction is the placement of the meatus in its anatomical position and the creation of functional genitalia with good cosmetic outcomes. Two different major reconstruction principals, the modified Cantwell-Ransley and the Mitchell Bagli repair, are used in specialized centers worldwide. Both procedures comprise the major principles of epispadias surgery but differ in timing and the extent of urethral mobilization. In addition, both techniques have advantages and specific risks involved, and reports from supporting institutions demonstrate favorable results. Regardless of the approach, the reconstruction should be performed by experienced surgeons.