Epispadias (II)

Epispadias (II)


Treatment of epispadias

Andrology – EURODOCTOR.RU – 2007

What is epispadias?

Epispadias – a rare congenital anomaly of genital organs. It's like opposite of hypospadias. If the hypospadias is the splitting of the rear wall of the urethra, then split the front wall epispadias the urethra.

The incidence of epispadias

Epispadias is much rarer than hypospadias. According to some researchers epispadias is one of 50,000 newborns. The ratio of newborn males and females as a 2.3: 1.

The causes of epispadias

The causes of epispadias, hypospadias, and like many other congenital anomalies, it is impossible to ascertain. This can be either a genetic predisposition, and plays a role adverse impact environmental conditions.

Classification of epispadias

Depending on the level splitting of the anterior wall of the urethra (starting from the head of the penis) distinguish epispadias:

  • head
  • stem,
  • and total.

Golovochnaya form of epispadias is characterized by the splitting of the urethra to the coronary sulcus of the penis. The penis in this form of epispadias more twisted and lifted up to the anterior abdominal wall. Urination is usually not disturbed. Erection of the penis and not broken. Sexual life with this form of epispadias is possible.
With the splitting of the stem epispadias the urethra up to the members – the pubic angle. This form is also accompanied by cleavage of the symphysis pubis bone, sometimes the difference of the abdominal muscles. The penis in these patients to the belly tucked up and a bit shortened. The urethral opening is shaped like a funnel. In this form of epispadias child can not urinate properly since the urine is sprayed, resulting in clothing becomes wet. The penis during erection deformed, resulting in sexual life impossible.
In total epispadias is split and the sphincter of the bladder. The urethra and looks like a funnel located just below the pubis. Due to the fact that this form of suffering and the urinary sphincter – the muscle responsible for opening and closing of the urethra – the urine of such patients allocated time. This causes maceration (corrosion) of the skin, dermatitis of the perineum, scrotum, inner thighs. The constant smell of urine soaking and deprives the child to attend kindergarten and school, play with peers scrotum and penis are underdeveloped, and their size is reduced. Accompanying the discrepancy pubic bone in these patients leads to the fact that they have observed so-called "duck walk". In this form, there are also epispadias and other anomalies of the genitourinary system, such as cryptorchidism.

Epispadias girls

This is a rare malformation of the urethra, which indicates the splitting of the front wall, the splitting of the clitoris and the difference in the direction of the labia.
In girls, this anomaly occurs in three forms:

  • clitoral epispadias form – in this form marked only the splitting of the clitoris, and above it opens the external opening of the urethra, which is shifted upwards. Urination is not violated.
  • subsimfizarnaya form – marked not only the splitting of the clitoris, labia minora and
  • complete epispadias – at the same time and split the clitoris and the labia, the external opening of the urethra is located behind the symphysis pubis. It is noted as the splitting of the symphysis pubis and the sphincter of the bladder.

Treatment of epispadias

As with hypospadias, epispadias treatment – operative.
Form of clitoral epispadias in girls and boys golovochnaya form does not require surgical treatment, unless they are accompanied by incontinence.
Currently, operations are performed for children aged 4 – 5 years. As with hypospadias, until recently, surgery for epispadias were carried out in several stages. Usually the first stage of correction of a narrowed external opening of the urethra, the second stage of the excised notochord (connective tissue cord, leading to a curvature of the penis) and straightened penis, and the third stage was carried plastic urethra.
At present, more and more popular are one-step operation.
The aim of surgery for epispadias is:

  • Correction of penile curvature,
  • recovery of a missing part of the urethra,
  • restoration of the normal appearance of the external genitalia,
  • if necessary – a reconstruction of the anterior wall of the bladder.
  • Depending on the complexity of defect operative technique has its own characteristics.
    Surgical technique for de-epispadias technique for hypospadias operations, with the only difference being that in epispadias restores the anterior wall of the urethra.
    Typically, the front wall to recreate the urethra using tissue of the foreskin. The distal portion of the urethra, together with its external orifice are excised. To determine the degree of penile curvature in its cavernous body injected saline, after which it takes shape as during erection. This facilitates the surgeon performing the operation. For the formation of a new wall of urethra into the bladder entered the plastic or silicone catheter for 8 – 10 days.

    Complications after surgery

    As with any surgery, complications can occur. Most often it is bleeding, infection of surgical wound dehiscence, fistula formation, followed by the urethra and swelling. The percentage of fistula and stricture formation of the urethra (the restrictions after the surgery) is on average 10%.

    Andrology and Urology Clinic of Professor GEPELYA – GERMANY
    Andrology and urology at the Medical Center Imedical – ISRAEL
    Clinic Andrology and genital surgery in MOSCOW

    Examination and treatment in GERMANY – Institute "DIAGNOSTIX"


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