Delayed-presenting penopubic epispadias in children: a case series highlighting surgical management and complications

Introduction and importance: Epispadias is a rare congenital anomaly involving dorsal displacement of the urethral meatus, often leading to functional and cosmetic concerns. In low-resource settings, delayed diagnosis is common due to limited awareness and sociocultural misinterpretation. Early surgical correction is essential for optimal outcomes. This series presents three pediatric cases managed with a modified Cantwell–Ransley urethroplasty. Case series: Three male patients aged 6, 11, and 12 years presented with dorsal urethral openings present since birth. Delayed presentation was noted in all cases due to misinterpretation, financial constraints, and prior inadequate management. The first case underwent primary modified Cantwell–Ransley repair but developed a postoperative urethrocutaneous fistula which was successfully repaired at a later stage. The second case had a preoperative urinary tract infection, which was treated prior to surgery, and showed an uncomplicated recovery despite an early urethral stent blockage. The third case involved a previous failed repair at a private medical center and required revision surgery with scar release and the use of a suprapubic pedicled flap for skin deficiency, resulting in a favorable outcome. Clinical discussion: The modified Cantwell–Ransley technique provided effective reconstruction, although complications such as fistulas may occur. The use of vascularized flaps was essential in complex and redo cases to achieve adequate coverage. Delayed presentation, prior failed procedures, and limited resources were the main challenges. Conclusion: Epispadias can be successfully managed with appropriate surgical techniques, even in challenging settings. Early diagnosis and specialized care improve outcomes, while delayed or failed cases require more complex reconstruction.