23 / 492
15:41 - 15:44
S2-3
(PP)
COMPLETE PENILE DISASSEMBLY FOR REPAIR OF EPISPADIAS CAUSES ERECTILE
TISSUE ALTERATIONS
Ali TOURCHI
1
, Heather DI CARLO
1
, Hiroshi MIYAMOTO
2
and John GEARHART
1
1) James Buchanan Brady Urological Institute, Division of Pediatric Urology, The Johns Hopkins Universi, Baltimore, USA
- 2) Departments of Pathology and Urology, Johns Hopkins University School of Medicine, Baltimore, USA
PURPOSE
Several cases of complete or partial penile corporal body loss have been reported following complete penile disassembly
for the repair of epispadias in the recent literature. Injury to the penile blood supply during radical soft-tissue
mobilization has been proposed as an etiology of this catastrophic complication. To better characterize the effects of the
current techniques for epispadias repair on corporal tissue, the authors investigate possible changes in vascularization
and viability of corpus cavernosa after complete penile disassembly and modified Cantwell-Ransley epispadias repair.
MATERIAL AND METHODS
The Johns Hopkins Committee for Animal Care and Use approved the experimental protocol (RB14M38). Sixty four
rabbits were allocated into four groups: Control group, Sham operation (penile degloving), complete disassembly model,
and Cantwel-ransley technique model. On weeks 2, 4, 12, and 24 post-op the penile tissue was harvested.
Immunohistochemical antibody staining was performed for endothelial (CD31) factor. Terminal deoxynucleotidyl
transferase biotin-dUTP nick end labeling (TUNEL) assay was used for the assessment of apoptotic indices.
RESULTS
The expression of CD31 and the number of microvessels was significantly(P<0.05) lower in complete disassembly group
compared to the other groups in all time points while no significant difference was observed between the Cantwell-
Ransley group, the sham operation and control group. Moreover, apoptosis was markedly increased in the group that
underwent complete disassembly technique when compared to sham or control group(p<0.05). However, the apoptosis
index was consistent between the sham, control and Cantwell-Ransley group.
CONCLUSIONS
Complete detachment of the urethra from corpus cavernosa may alter the endothelial and vascular structure of erectile
tissue and increases the apoptotic process in cavernosal cells, possibly causing erectile dysfunction as these patients
age. Further studies are needed to evaluate the effect of complete and partial urethral detachment on erectile function.