Male Epispadias, Genitourinary Implications

Male epispadias is a rare and challenging urologic condition. As part of the epispadias-exstrophy complex of genitourinary anomalies, it covers a broad spectrum with the mildest forms being the rarest. The anatomic classification into glanular, penile, and penopubic is based on the location of the urethral meatus. However, this classification fails to include some of the extragenital malformations that may be present such as pubic diastasis, bladder neck abnormalities, diminished bladder capacity or function, and vesicoureteral reflux. Careful individualized evaluation should allow the identification of these anomalies and will help achieve the goals of surgical reconstruction for the immediate and long-term care of these patients. These goals include cosmetic and functional reconstruction of the penis and urethra as well as, when needed, creation of a continence mechanism that will allow for normal bladder function, storage and evacuation of urine. This chapter will focus on: the evolution of techniques for male epispadias repair; preoperative evaluation and management of male patients with epispadias; considerations for the surgical management based on the anatomic classification; and discussion of associated anomalies.