Ureteric Orifice Size in Primary Epispadias: A "New" Observation

Abstract Objectives: To investigate the observation that children with primary epispadias frequently exhibit stenotic ureteric orifices, in contrast to patients with classic bladder exstrophy. Design: Retrospective observational study. Setting: Single tertiary paediatric urology centre. Participants: Children with incontinent primary epispadias who underwent bladder reconstruction between January 2005 and December 2006. Primary Outcome Measures: Ureteric orifice calibre, size of ureteric catheter successfully inserted, and presence or absence of upper tract dilatation on imaging. Results: Eleven patients (8 males, 3 females; age range 12–68 months, mean 43 months) were included. Three patients (1 male, 2 females) had ureteric orifices that accepted 6F catheters without difficulty. In the remaining eight patients (6 males, 2 females), one or both ureteric orifices were too narrow to accept a 6F catheter during primary reconstruction. These orifices admitted only 3F–4F catheters, often after dilatation. Pre‑ and postoperative ultrasonography demonstrated no upper tract dilatation in any patient. Conclusions: A ureteric orifice size of at least 6F is generally expected in children of this age group undergoing bladder reconstruction. The unexpectedly high prevalence of stenotic ureteric orifices in primary epispadias suggests a previously under‑recognised anatomical association. This may reflect abnormal trigonal development, complementing the well‑described continence abnormalities in this population. The contrast with bladder exstrophy highlights potential embryological differences between these conditions.