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Phalloplasty in Boys with Cloacal Exstrophy.
S76 capacity. All females are dry by day, 1 also at night.
CONCLUSIONS As in patients with bladder exstrophy, continence relies on a combination of bladder outlet resistance and capacity.
ESPU Programme 2008 Whilst the results from secondary cases are comparable with our data in classic exstrophy (70% daytime continence) those in primary cases are inferior. Reasons for this may include: 1. patients with primary operations are younger and so their continence may continue to improve. 2. radical primary dissection may have
a negative effect on native continence mechanisms in epispadias. 3. primary epispadias is not simply a more minor variant of the exstrophy-epispadias complex. (supported by anatomical observations of our cases).
From 12:51 to 12:54 # S17-3 (PP) PHALLOPLASTY IN BOYS WITH CLOACAL EXSTROPHY. Piet HOEBEKE, Stanislas MONSTREY*, Peter CEULEMANS*, Nicolaas LUMENy, Katrien KLOCKAERTSz, Erik VAN LAECKE{ Ghent University Hospital, Paediatric Urology & Urogenital reconstruction, Gent, BELGIUM - *Ghent University Hospital, Plastic Surgery, Gent, BELGIUM - yGhent Univesrity Hospital, Urology, Gent, BELGIUM - zGhent University Hospital, Paeditric Urology, Gent, BELGIUM - {Ghent University Hospital, Paediatric Urology, Gent, BELGIUM
PURPOSE
MATERIAL AND METHODS
CONCLUSIONS
Cloacal exstrophy is considered one of the most serious congenital anomalies. Boys present with insufficient penile development and formerly female gender reassignment was considered the treatment of choice. Recently bad outcome was reported in female assigned patients, so male gender assignment is preferred (1-2). In male gender assignment subsequent phalloplasty will be necessary. Due to former surgery in the pelvic region the gold standard phalloplasty using free tissue transfer is not preferred. We therefore offered a pedicled tissue transfer (anterolateral tigh flap ALT) to 2 boys with cloacal exstrophy and raised as boys.
Two boys, age 17 and 18 years were seen after multiple reconstructions for cloacal exstrophy. They both had an augmented bladder with closed bladder neck and continent vesicostomy. In both boys a phalloplasty was done using an ALT flap. No urethral reconstruction was done as it was uneccesary. The urethra was left open at the base of the phallus for eventual sperm evacuation.
With male gender assignment as gold standard approach to boys with cloacal exstrophy, we present the ALT flap as the method of choice for penile reconstruction.
RESULTS Both procedures were uneventfull and in both patients a satisfactory result could be obtained. Both boys expressed their extreme hapiness with the result. Erectile devices will be implanted after 1 year.
REFERENCES Reiner WG: Psychosexual development in genetic males assigned female: the cloacal exstrophy experience. Child Adolesc Psychiatr Clin N Am. 2004 Jul;13(3):657-74 Meyer-Bahlburg HF: Gender identity outcome in female-raised 46, XY persons with penile agenesis, cloacal exstrophy of the bladder, or penile ablation. Arch Sex Behav. 2005 Aug;34(4):423-38.
From 12:54 to 12:59# S17-4 (O) SELF-ESTEEM AND SATISFACTION WITH PENILE APPEARANCE IN ADOLESCENT MALES WITH BLADDER EXSTROPHY: A PILOT STUDY Raimondo CERVELLIONE, Ruth HURRELL*, Sarah GASKELL*, Janet FISHWICK, A BIANCHI, Alan DICKSON Royal Manchester Childrens Hospital, Urology, Manchester, UNITED KINGDOM - *Booth Hall Childrens Hospital, Clinical Psychology, Manchester, UNITED KINGDOM
PURPOSE
MATERIAL AND METHODS
Self-esteem can play an important role in satisfaction with body appearance. The present pilot study was designed to examine the relationship between self-esteem and satisfaction with penile appearance in adolescent males with bladder exstrophy and/or epispadisas.
Nine adolescent males aged 11-16 with bladder exstrophy or primary epispadias were identified in the Manchester Bladder Exstophy database. Six took part in the study completing a ‘satisfaction with penile appearance’ questionnaire and the Harter Self-Perception Profile to provide a global measure of self-worth. Standarised
photographs were taken of each participant’s genital area. Two Paediatric Urologists independently rated participants’ penile appearance based on the anonymised photographs using a penile appearance rating scale. Each participant’s genital developmental stage was assessed using the Tanner Rating Scale.
CONCLUSIONS As in patients with bladder exstrophy, continence relies on a combination of bladder outlet resistance and capacity.
ESPU Programme 2008 Whilst the results from secondary cases are comparable with our data in classic exstrophy (70% daytime continence) those in primary cases are inferior. Reasons for this may include: 1. patients with primary operations are younger and so their continence may continue to improve. 2. radical primary dissection may have
a negative effect on native continence mechanisms in epispadias. 3. primary epispadias is not simply a more minor variant of the exstrophy-epispadias complex. (supported by anatomical observations of our cases).
From 12:51 to 12:54 # S17-3 (PP) PHALLOPLASTY IN BOYS WITH CLOACAL EXSTROPHY. Piet HOEBEKE, Stanislas MONSTREY*, Peter CEULEMANS*, Nicolaas LUMENy, Katrien KLOCKAERTSz, Erik VAN LAECKE{ Ghent University Hospital, Paediatric Urology & Urogenital reconstruction, Gent, BELGIUM - *Ghent University Hospital, Plastic Surgery, Gent, BELGIUM - yGhent Univesrity Hospital, Urology, Gent, BELGIUM - zGhent University Hospital, Paeditric Urology, Gent, BELGIUM - {Ghent University Hospital, Paediatric Urology, Gent, BELGIUM
PURPOSE
MATERIAL AND METHODS
CONCLUSIONS
Cloacal exstrophy is considered one of the most serious congenital anomalies. Boys present with insufficient penile development and formerly female gender reassignment was considered the treatment of choice. Recently bad outcome was reported in female assigned patients, so male gender assignment is preferred (1-2). In male gender assignment subsequent phalloplasty will be necessary. Due to former surgery in the pelvic region the gold standard phalloplasty using free tissue transfer is not preferred. We therefore offered a pedicled tissue transfer (anterolateral tigh flap ALT) to 2 boys with cloacal exstrophy and raised as boys.
Two boys, age 17 and 18 years were seen after multiple reconstructions for cloacal exstrophy. They both had an augmented bladder with closed bladder neck and continent vesicostomy. In both boys a phalloplasty was done using an ALT flap. No urethral reconstruction was done as it was uneccesary. The urethra was left open at the base of the phallus for eventual sperm evacuation.
With male gender assignment as gold standard approach to boys with cloacal exstrophy, we present the ALT flap as the method of choice for penile reconstruction.
RESULTS Both procedures were uneventfull and in both patients a satisfactory result could be obtained. Both boys expressed their extreme hapiness with the result. Erectile devices will be implanted after 1 year.
REFERENCES Reiner WG: Psychosexual development in genetic males assigned female: the cloacal exstrophy experience. Child Adolesc Psychiatr Clin N Am. 2004 Jul;13(3):657-74 Meyer-Bahlburg HF: Gender identity outcome in female-raised 46, XY persons with penile agenesis, cloacal exstrophy of the bladder, or penile ablation. Arch Sex Behav. 2005 Aug;34(4):423-38.
From 12:54 to 12:59# S17-4 (O) SELF-ESTEEM AND SATISFACTION WITH PENILE APPEARANCE IN ADOLESCENT MALES WITH BLADDER EXSTROPHY: A PILOT STUDY Raimondo CERVELLIONE, Ruth HURRELL*, Sarah GASKELL*, Janet FISHWICK, A BIANCHI, Alan DICKSON Royal Manchester Childrens Hospital, Urology, Manchester, UNITED KINGDOM - *Booth Hall Childrens Hospital, Clinical Psychology, Manchester, UNITED KINGDOM
PURPOSE
MATERIAL AND METHODS
Self-esteem can play an important role in satisfaction with body appearance. The present pilot study was designed to examine the relationship between self-esteem and satisfaction with penile appearance in adolescent males with bladder exstrophy and/or epispadisas.
Nine adolescent males aged 11-16 with bladder exstrophy or primary epispadias were identified in the Manchester Bladder Exstophy database. Six took part in the study completing a ‘satisfaction with penile appearance’ questionnaire and the Harter Self-Perception Profile to provide a global measure of self-worth. Standarised
photographs were taken of each participant’s genital area. Two Paediatric Urologists independently rated participants’ penile appearance based on the anonymised photographs using a penile appearance rating scale. Each participant’s genital developmental stage was assessed using the Tanner Rating Scale.