Epispadiasis

1. Ratheesh.R
SLMGNC

2. Introduction:
 An epispadias is a rare type
of malformation of the penis in which
the urethra ends in an opening on the
upper aspect (the dorsum) of the penis. It
can also develop in females when the
urethra develops too far anteriorly.

3. Definition:
 It is a rare congenital condition in
which the Urethral Meatus opens
dorsally on top of the penis, proximal
to the glans.
 Incidence – 1 in 120,000 male and 1 in
500,000
female births.
 Occurance – More common in male than in
girls.

4. Etiology:
 Unknown
 Inguinal hernia
 Male siblings
 Improper development of the pubic bone
 Birth Defect
 Other Genito urinary defects.

5. Clinical Manifestation:
In males:
 Abnormal opening from the joint between the
pubic bones to the area above the tip of the
penis
 Backward flow of urine into the kidney (reflux
nephropathy)
 Short, widened penis with an abnormal
curvature
 Urinary tract infections
 Widened pubic bone

6. Cont….
In females:
 Abnormal clitoris and labia
 Abnormal opening from the bladder neck to
the area above the normal urethral opening
 Backward flow of urine into the kidney (reflux
nephropathy)
 Widened pubic bone
 Urinary incontinence
 Urinary tract infections

7. Diagnostic Findings:
 History Collection
 Physical Examination
 Blood test to check electrolyte levels
 Intravenous pyelogram (IVP), a special X-ray
of the kidneys, bladder and ureters
 MRI and CT scans, depending on the
condition
 Pelvic X-ray
 Ultrasound of the urogenital system

8. Treatment:
Surgical repair of epispadias is recommended in
patients with more than a mild case.

9. Cont….
After surgery:
 Depending on the extent of surgery, the child
may either go home the same day or stay in the
hospital overnight.
 The Children's nurses will talk with, how to care
for him at home and will provide detailed
instruction sheets (how to manage his dressing,
what activities should be avoided, etc.)

10. Cont….
For the child's recovery period, the doctor may
prescribe any or all of the following:
 Acetaminophen (Tylenol), to help ward off
soreness in the first few days after surgery
 Antibiotic ointment, to be applied to the penis
several times a day
 Oral antibiotics
 Antispasmodic medication, to alleviate bladder
spasms

11. Nursing Diagnosis:
 Pain r/t surgical incision and drainage tube.
 Risk for infection r/t surgical incision and
drainage tube.
 Body image disturbance r/t Appearance of
genitalia.
 Impaired urinary elimination r/t the condition
and surgical intervention.
 Risk for fluid volume deficit r/t surgical losses.

12. Complication:
 Abnormal opening from the bladder neck to
the area above the normal urethra opening.
 Backward flow of urine into the kidney (reflux
nephropathy)
 Urinary incontinence.
 Urinary tract infections.
 Widened pubic bone.