Epispadias

An epispadias is a congenital defect of the urinogenital tract. The abnormality occurs in 1 in 10000 live male births. The urethra opens on the upper surface of the male reproductive organ instead of at the tip. At some stage in foetal development of the pubic bone, tissue folds inward and forms the urethra. The opening for urine is located on the upper surface

  • In males the typical signs of this disorder are:
  • Abnormal opening from the joint between the pubic bones to the area above the tip of the penis
  • Urethral opening on upper side of penis
  • Backward flow of urine into the kidney
  • Short, widened penis with an abnormal curvature
  • Recurrent Urinary tract infections
  • Widened pubic bone

Causes:

There seems to be no genetic cause of epispadias. Maternal exposures to toxic drugs which affect the endocrine system also cause this disorder.


This disorder manifests as an opening the front wall of the urinary bladder which extends up to the abdominal wall. In males, the opening of the bladder extends up to the urethra. The urine exits from the urethra in an abnormal position. Individuals with this disorder are unable to inseminate the female partner due to the abnormal opening of the penile opening.


Male external urinary tract defects are discovered at birth in the course of a physical examination. Imaging technology may be used to detect the severity of the condition.

Treatment

  • Prior to treatment the following tests may be carried out;
  • Electrolyte level Blood test
  • X-ray of the kidneys, bladder, and ureters
  • MRI and CT scans
  • Pelvic x-ray
  • Ultrasound of the urogenital system

Surgery at the earliest is the only remedy for this condition. Aesthetic surgery for this defect involves making an opening to allow for insemination as also for urinary continence. Modern surgical procedures have an 80 per cent success rate.


The surgical procedures adopted are intended to:

  • correct the curvature
  • Reconstruct the missing portion of urethra
  • Restore the normal appearance of the external genitalia,
  • Reconstruct the anterior wall of the bladder when necessary.

After surgery, leg restraints and urinary catheter may be necessary for a few days. The catheter is removed when the patient is able to void his bladder without difficulty. Complications from the surgery may include bleeding from the operation site, secondary infection and edema.


The prognosis for males affected with tis disorder is bright. Post-surgery, most of them are able to father children and control urine flow


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