epispadias

epispadias

Epispadias is a malformation of the urethra, characterized by the absence of more or less of its upper wall. Often combined with other malformations: cryptorchidism, testicular and prostate hypoplasia, anomalies of the upper urinary tract. Frequency – 1/50,000 newborns.

Etiology

    • Abnormal development of the urogenital sinus, genital tubercle, and urogenital membrane
    • As a result of the displacement of the urethral plate, the urogenital membrane is located above the genital tubercle
    • Sexual folds do not grow together.

The clinical picture depends on the form of epispadias.

    • Epispadias of the glans penis
    • Splitting of the spongy body of the glans penis along the upper plane
    • The external opening of the urethra is located on the coronary sulcus
    • Urination is not disturbed
    • With an erection, a non-cordial curvature of the penis upwards – sexual intercourse is possible.
    • Epispadias of the penis
    • The penis is flattened, shortened, curved upward
    • The foreskin on the upper plane is absent
    • The external opening of the urethra is located on the body of the penis
    • Significant splashing of urine when urinating. Possibility of urinary incontinence due to tension of the abdominal muscles
    • Pronounced deformation and curvature of the penis during erection – difficulty or improbability of sexual intercourse.
    • Total epispadias – the absence of the anterior wall throughout the cavernous bodies and the sphincter of the bladder
    • The penis is underdeveloped, curved upwards, pulled up to the abdomen
    • External opening in the form of a wide funnel at the base of the penis
    • True urinary incontinence – maceration of the skin of the perineum and thighs
    • Divergence of the bones of the pubic joint – duck gait, flattened abdomen
    • Sexual intercourse is not possible.

Treatment:

Tactics of conducting

    • With epispadias of the head, as a rule, there will be no need for correction. In other cases, surgical treatment is indicated, aimed at restoring the urethra, the neck of the bladder, correcting the deformity of the penis
    • Operative correction is performed at the age of 4-5 years.
    • Before the operation, it will be necessary to eliminate diaper rash and maceration of the skin. Surgery. Perform either the closure of the defects of the bladder and the anterior abdominal wall, or the removal of the organ with the further removal of the ureters into the sigmoid colon or on the skin.

Synonyms

    • Upper urethral occlusion
    • Upper cleft urethra

ICD. Q64.0 Epispadias

Note. Epispadias can develop in girls—probably splitting of the clitoris or shortening of the urethra, damage to the bladder neck.

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