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Objectives To describe our experience performing the modified penile disassembly technique for boys with epispadias and for those undergoing complete primary repair of exstrophy. Methods Between January 2004 and July 2009, 34 boys underwent the modified penile disassembly technique at our institution. The first group included 15 boys with bladder exstrophy who underwent complete primary repair of exstrophy. The second group comprised 11 boys with penopupic epispadias after previous closure of bladder exstrophy. The third group included 8 boys with isolated complete epispadias. Results The age range was 3 months to 8 years (median, 9 months). The follow-up time ranged from 36 months to 8 years (mean, 63 months). A conical-shaped glans with the absence of any ischemic changes occurred in 94% of patients. A mild degree of penile dorsal tilt occurred in 11.7% of patients, urethrocutanous fistula in 17.6% and meatal stenosis 5.8%. In cases of complete primary repair of exstrophy, hydronephrosis occurred in 66.6% of patients. Vesicoureteral reflux appeared in 60% of patients; despite suppressive antibiotic therapy, 33.3% are awaiting reimplantation. Continence with volitional voiding with dry intervals of ≥3 h was achieved in 40% of patients. Conclusions The modified penile disassembly technique can be used in epispadias and complete primary repair of exstrophy with excellent cosmetic results. Preservation of the distal urethral plate along with both hemiglans avoids shortening and prevents occurrence of hypospadias. Complete primary repair of exstrophy is a feasible technique with positive effects on continence with preservation of kidney function.

summary report on the management of ureteral calculi. J.Urol. 1997; 158 : 1915–21.2Tawfiek ER, Bagley DH. Management of upper urinarytract calculi with ureteroscopic techniques. Urology 1999; 53 : 25–30.3Pollard SG, MacFarlane R. Symptoms arising from double-J ureteral stents. J. Urol. 1988; 139 : 37–41.4 El-Faqih SR, Shamsuddin AB, Chakrabarti A. Polyurethaneinternal ureteral stents in the treatment of stone patients:morbidity related to indwelling times. J. Urol. 1991; 146 :1487–91.5 Damiano R, Oliva A, Esposito C, De Sio M, Autorino R,D’Armiento M. Early and late complications of double pig-tail ureteral stent. Urol. Int. 2002; 69 : 136–40.6 Damiano R, Autorino R, Esposito C et al. Stent positioningafter ureteroscopy for urinary calculi: the question is stillopen. Eur. Urol. 2004; 46 : 381–8.7 Moon TD. Ureteral stenting – an obsolete procedure? J.Urol. 2002; 167 : 1984.8 Hosking DH, McColm SE, Smith WE. Is stenting followingureteroscopy for removal of distal ureteral calculi neces-sary?