**Introduction:**
Epispadias is a rare congenital malformation affecting the genitourinary system. This condition disrupts the normal development of the urethra and surrounding structures during fetal growth. Understanding epispadias involves delving into its definition, types, signs and symptoms, as well as the diagnostic evaluation methods employed to assess this anomaly.
**Definition:**
Epispadias is a congenital anomaly where the urethral opening is positioned on the upper side of the penis rather than its usual location at the tip. This abnormality can extend to involve the bladder and adjacent structures, impacting urinary and reproductive functions.
**Types:**
Epispadias is categorized into three main types based on the severity of the malformation: glandular, penile, and penopubic. Glandular epispadias involves the urethral opening being near the glans, while penile epispadias extends along the penile shaft. Penopubic epispadias is the most severe type, reaching the pubic region.
**Signs and Symptoms:**
Common signs of epispadias include an abnormally placed urethral opening, exposed glans, and a widened pubic gap. Individuals with epispadias may experience urinary incontinence, as the abnormal positioning of the urethra can affect urinary control. Additionally, this condition may be associated with other genitourinary abnormalities.
**Diagnostic Evaluation:**
Diagnosing epispadias involves a thorough clinical examination and imaging studies. Physical examination may reveal the characteristic features, while imaging techniques such as ultrasound, magnetic resonance imaging (MRI), or voiding cystourethrogram (VCUG) can provide detailed insights into the extent of the malformation and associated abnormalities. Timely and accurate diagnosis is crucial
8. ✓Epispadiasis is a rare type of malformation of
the penis.
✓Itcan also develop infemales.
✓Epispadiasis is a rare congenital ( present from
birth ) defect in the location of the opening of the
urethra .
10. According to Brunner and Siddarth, "
congenital (at birth) malformation inwhich
the opening of the urethra is abnormalon
the dorsal aspect of thepenis."
14. Inmale,the urethra general opening
abnoramally inany parts ofthe peinis.
Infemale, the urethra opening is
usually between the clitoris andthe
labia, but abnormal open inthe
abdomen wall.
15. -Epispadiasis can be
associated bladder
extropy( an
uncommon birth
defect in which
bladder is inside out
and sticks through
the abdominal wall).
19. 1
.PenopubicEpispadiasis
This is where the
urinary meatus is
found close to the
body, potentially not
on the penis butnear
the pubic bone at the
base of penis.
20. 2. Penile Epispadiasis
The meatus is found on
the shaft of the penis,any
where before the head of
the penis but more above
the base where the shaft
meets the body
21. 3..Glandular Epispadiasis
This is where the
urinary meatus is found
on the head of the
penis, but on the top
than inthe standard
location at thetip.
24. Embryology :-
✓There is disorder of the mesoderm cellmigration during
the 4th developmental week.
✓Impaired genital formation that fuse on the midline of
the form the genital tubercle at the 5th week of
development.
25. ✓The urethra does not develop into a fulltube.
✓Exstrophy of bladder (anterior wall of the abdomenand
bladder are absent).
✓Epispadiasis
27. •usually have a short,wide
penis with an abnormal
curve.
•Backward flow of urineinto
the kidney .(Refux
nephropathy)
•Abnormal clitrois and labia.
•Abnormal opening from the
bladder neck to the area the
normal urethral opening .
SIGN ANDSYMPTOMS
Inmale Infemale
39. 2. Surgical management
A.The Modified cantwell Ransely Repair :-
– The modified Cantwell technique involves "
Rebuilding " the penis. Ittakes some of thepenis
apart to move theurethra to normal position.
40. 2. Surgical management
B.The MitchellTechnique :-
– Itinvolves taking the penis apart completely, then
putting itback together. This is done so the urethra is
the most functiona works. Itinvolves inshorteen of
penis.
41. 2. Surgical management
C. Surgical technique infemales :-
– Ifdiagnosed at birth,parts of the clitoris can be
brought together and the urethra can be placed into
normal position.
42. 2. Surgical management
–If the vaginal opening is narrow inolder girls or
younger women, reconstruction can be performed
after puberty.
