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VR-38
(VS)
KELLY PROCEDURE FOR MALE PRIMARY EPISPADIAS
Pankaj MISHRA, Simon RAJENDRAN, Maria ASIMAKIDOU and Imran MUSHTAQ
GREAT ORMOND STREET HOSPITAL, PAEDIATRIC UROLOGY, London, UNITED KINGDOM
PURPOSE
Primary epispadias is a rare congenital malformation involving the urogenital system. In patients with epispadias,
bladder closure enhances bladder growth and continence.
MATERIAL AND METHODS
This video aims to demonstrate the Kelly procedure for primary epispadias in a male child.
A lower midline incision is employed extending down to the sub-coronal region, degloving the penis, exposing the full
length of its attachment. The urinary bladder is mobilised and the inter-pubic ligament is divided in the midline. The
prostate and bladder neck is separated from the symphysis and the pelvic floor muscles are delineated and divided. The
fat in the ischio-rectal fossa is visualised and swept inferiorly to give access to Alcock’s canal. The pudendal
neurovascular bundle is identified and preserved. Mobilisation of the corpora cavernosa along with periosteum begins at
the anterior pubic surface and extends posteriorly. These steps bring the bladder neck to the midline and allow tension
free bladder neck reconstruction and recreation of the natural angulation of urethra.
The urethral plate, penile shaft is dissected and corpora cavernosa are separated. The bladder neck repair is performed.
The urethral plate is tubularised and brought ventrally. The separated corpora are reapposed avoiding torsion. The skin
is reoriented to provide cover to the penis.
RESULTS
The Kelly procedure improves cosmesis and continence by reconstructing a tension free bladder neck repair and
lengthening the penis.
CONCLUSIONS
This video demonstrates the Kelly procedure for primary epispadias in a male child.