Preoperative evaluation ofseverity of malformation of penisin boys with epispadias and bladder exstrophy

Rudin Yu.E., Maruhnenko D.V., Aliev D.K.

Introduction. Epispadiasis a severe congenital malformation and is often combinedwith other anomalies: bladder exstrophy, cryptorchidism, inguinal hernia, vesicoureteral reflux, megaureter, buried penis and urinary incontinence. Such diseases affect the quality of life and furthertreatment prognosis.

Materials and methods: 134 patients who underwentsurgery from 2010 to 2016 for epispadias and bladder exstrophy aged 1 to 17 years were retrospectively examined. There were 45 patients with epispadias, and 89 – with bladder exstrophy. All patients underwent standard examination, but special attention was paid to the study of localstatus. Physical examination assessed the appearance, the total length of the penis, the location of the meatus, the shape and diameter of the meatus, the width and length of the urethral plate, the degree of corporal deformation. To objectify the evaluation of the degree of anomalies at the preoperative stage,we developed an analogue scale that allows usto classify the manifestations of a clinical case by severity. Each criterion, depending on its severity, we assigned a quantitative value from 0 to 3. The minimal possible score on the scale of preoperative evaluation is 0 points, the maximum is 32 points. e score on this scale reflects the severity of the exstrophy-epispadias complex, helpsto determine furthertreatment tactics and a possible prediction of the number of complications of surgical intervention.

Results: The results of the examination, recorded in the scale of preoperative assessment of the severity of the congenital defect of the penis, were grouped according to the number of points.Thus,we formed 4 groups of gravity. Complications in the first observation group were 7.69%, in the second group – 18.44%. Complications in the third group were 29.69% and in the fourth group – 42,86%.

Conclusions: the analogue scale allows to standardize the approach to epispadias treatment, as well as to predict the possible percentage of complications depending on the severity of the manifestations.

Authors declarelack of the possibleconflicts of interests

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pediatric urology; epispadias; bladder exstrophy; standardization of treatment; scale of objective evaluation of epispadias; prognosis of complications