Isolated Female epispadias, without the presence of bladder exstrophy, is a very rare congenital anomaly that affects 1 in 484,000 females. In this video, we aim to describe the steps for BMG repair for a patient with female epispadias. We believe this is the first time this has been performed for this rare condition.

A 15-year-old female, with normal developmental milestones, had a long-standing history of urinary incontinence requiring the use of 12 pads/day (1.1 kg 24-hour pad weight). The patient had a significant history of VACTERL associations, including anorectal malformation, which was previously corrected via a 3-stage posterior sagittal anorectoplasty. She had recurrent urinary tract infections, but otherwise had normal renal function. The patient had not received prior surgery to correct the primary anatomical problem, as her parents were not keen.

Urethrocystoscopy showed a deficient anterior urethra from 11-2 o’clock with a wide open bladder neck despite multiple previous periurethral and bladder neck deflux injections. The patient underwent a single stage BMG urethroplasty. The surgery was performed through a supraurethral incision from 9-2 o’clock followed by hydro-dissection with 20ml of 0.5% bupivacaine and adrenaline. The urethra was then mobilised to the bladder neck. This was followed by urethrotomy and deepithelialisation of the deficient urethra. An inlay urethroplasty was then performed using a 2x1 cm BMG with absorbable sutures over a 18Fr catheter. The BMG was quilted to the corpora bodies anteriorly to aid imbibition and inosculation. Continence was demonstrated at the end of surgery using Crede’s manoeuvre.

The patient’s catheter was kept for a total of 3 weeks. She was able to void after removal of the catheter, with good uroflowmetry results of Qmax 18.4ml/sec, voided volume of 179ml and minimal residual urine. At 6 weeks followup, she reported much improved continence, needing only 4 pads per day. The patient had also started participating in physical sports, something that she was never able to do before.

Our attempt to alleviate incontinence in this patient with primary epidpadias is moderately successful. Further follow-up is needed to determine long term results.