Isolated primary mid-shaft epispadias in a 1-year-9-month-old male: a case report from a resource-limited setting

Background: Epispadias is a rare congenital urethral anomaly occurring in approximately 1 in 100 000 live male births. Isolated mid-shaft epispadias without bladder exstrophy is exceptionally uncommon. Early diagnosis and surgical repair are essential for functional and cosmetic restoration. Case presentation: We report a 1-year-9-month-old male from a rural area, presenting with difficulty urinating since birth and recurrent urinary tract infections. Examination revealed a buried phallus, bifid glans, mild dorsal chordee, and a dorsally located mid-shaft urethral meatus. Both testes were normally descended, and no associated anomalies were identified. Renal ultrasonography and cystoscopy demonstrated normal upper urinary tracts, an intact bladder neck, and preserved continence potential. A diagnosis of isolated primary mid-shaft epispadias was established. Surgical repair was performed using circumferential penile degloving, fibrosis release, dorsal urethroplasty with tubularization of the urethral plate over an 8-Fr catheter, glanuloplasty, and dartos flap coverage. Postoperatively, the child received intravenous ceftriaxone, paracetamol-based analgesia, catheter care, and wound monitoring. The urethral catheter remained for 21 days to facilitate urethral healing. Recovery was uneventful. At the 3-month follow-up, the child demonstrated a satisfactory urinary stream, good cosmetic appearance, and absence of fistula, meatal stenosis, or recurrent chordee. Discussion: Isolated mid-shaft epispadias is exceedingly rare and may be misdiagnosed in resource-limited settings. Careful clinical evaluation and meticulous urethral reconstruction can achieve favorable early outcomes. Conclusion: Successful management of isolated mid-shaft epispadias is achievable in low-resource settings through appropriate surgical planning and postoperative care.