Division of Urology

Reconstructive Urologic Surgery in Children

The reconstructive surgery program in the Division of Urology pioneered many of the surgical procedures that are used throughout the world today. These include repairs for hypospadias, bladder exstrophy, cloacal exstrophy, epispadias and disorders of sex development.

Hypospadias

Hypospadias is a condition that affects the development of the urethra and the tissues that make up the undersurface of the penis. This is consistently one of the most common diagnoses we treat, with visits for hypospadias totaling more than 1,200 annually.

Hypospadias repair

Procedures to correct hypospadias include the meatal advancement and glanduloplasty (MAGPI) repair, transverse island flap repair, and the island tube repair. These techniques, originally described by surgeons at CHOP, have been refined over the years and have significantly improved the surgical outcome of children with hypospadias.

Our Division is committed to the care of children with complex hypospadias, following them throughout childhood and adolescence as needed. We specialize in working with children who have undergone failed procedures and are seeking options for reconstruction. Our dedicated team, including a pediatric psychologist, is available to work with families through toilet training, to help children cope with any procedures necessary as they get older, and to work on issues related to body image, if appropriate.

Research

We are conducting research into genital wound healing to try and identify the factors associated with improved appearance and fewer complications following hypospadias repair.

Exstrophy and epispadias

Exstrophy and epispadias are rare, complex congenital conditions, but our Division has tremendous experience in treating children with these conditions since our inception in the 1970s. In 2010, we completed almost 400 outpatient appointments for patients with bladder or cloacal exstrophy and/or epispadias.

Specialized team

We have a specialized team of providers to care specifically for children with exstrophy and/or epispadias and their families. Our surgical team includes urologists, Michael Carr MD, PhD, and Douglas Canning MD, and an orthopedic surgeon who work together to do this repair. Our research has shown that having an orthopedist do osteotomies during the first surgery makes a difference in long-term continence, especially for our patients with epispadias. During the osteotomy the hip bones are cut and adjusted.

We utilize the complete primary repair of bladder exstrophy, meaning the bladder is closed at the same time the urethra is reconstructed. Further reconstructive work to repair any urethral or penile issues may be safely accomplished in a subsequent surgery. Our goal is to have the bladder fill and empty normally so we can achieve normal bladder function.

After surgery

After the initial surgery, our team will follow your family closely. We will see your child routinely and we will obtain regular ultrasounds to ensure your child’s bladder and kidneys continue healthy development. In addition to our surgeons, you will meet our psychologist, who will remain available to you and your child throughout your care at CHOP.

In addition to the physical aspects of exstrophy and epispadias, there are emotional issues that arise for many children and their families throughout the course of the child’s development. For example, some children wonder how to explain their surgical scars to peers. Others struggle to manage issues related to their continence. Most, if not all, parents experience very complicated feelings about having a child with a chronic medical condition. We expect children will have periods of time when things seem to be going well and others where the challenges of their medical condition seem to be a greater burden. As a Division, we believe helping you manage these issues is as important as any surgical work we do. Our entire team is available to your family as you manage these complex conditions over time.

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