SlideShare a Scribd company logo
EPISPADIAS
BY
RAJAH AMINA SULEIMAN
INTRODUCTION
 Epispadias is a rare congenital malformation of the male or female urogenital organs that
consists of a defect of the dorsal wall of the urethra.
 In boys with epispadias, the urethra generally opens on the top or side of the penis rather
than the tip.
 However, it is possible for the urethra to be open along the entire length of the penis. In
girls, the opening is usually between the clitoris and the labia but may be in the abdominal
area.
 Epispadias can be associated with bladder exstrophy.
DEFINITION
 Epispadias is a rare urogenital malformation characterized by the failure of
the urethral tube to tubularize on the dorsal aspect.
 Epispadias is an abnormality of the urethra in which the urethral opening is
ectopically located on the dorsal aspect of the penis.
INCIDENCE
 Epispadias occurs in
 one in 117,000 newborn boys
 one in 484,000 newborn girls.
 It is commonly seen as a component in the spectrum of bladder exstrophyepispadias-
complex (BEEC).
 Isolated epispadias constitutes less than 10 percent of the total cases of epispadias.
 Isolated male epispadias is rare.
ETIOLOGY
 Epispadias can be explained by defective migration of the paired primordia of the genital
tubercle that fuse on the midline to form the genital tubercle at the fifth week of
embryologic development.
 Epispadias is rarely observed in 2 members of the same family.
CLASSIFICATION
 Glandular
 Penile
 Complete (ie, penopubic).
FEMALE EPISPADIAS
 Isolated female epispadias without bladder exstrophy is an extremely rare congenital
anomaly.
 The symptoms of female epispadias are primary urinary incontinence and abnormal
anatomical features.
 In females, epispadias consists of bifid clitoris with diastases of the corpora cavernosa,
flattening of the mons, and separation of the labia.
CLINICAL MANIFESTATION (MALE)
 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
CLINICAL MANIFESTATION (FEMALE)
 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
DIAGNOSIS
 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
SURGICAL MANAGEMENT
 Surgical management of epispadias is challenging and requires technical expertise.
 The surgery aims to reconstruct the genitalia and urethra, providing optimal functional and
cosmetic outcomes.
 At present, surgeons across the world have adopted either of the two following approaches:
 Modified Cantwell-Ransley repair
 Complete penile disassembly technique (Mitchell and Bagli)
NURSING MANAGEMENT
 Assess the newborns flow of urine, exit site, and angle of urination
 Infant/child returns from surgery w/ penis wrapped in a simple dressing and a stent or
catheter for
 urinary drainage
 Fresh blood may be seen on the dressing and in the stent or catheter in the immediate
postop period, but the urine should become less bloody over the next few hours
 Encourage fluid intake to maintain adequate urinary output and patency of the stent
NURSING MANAGEMENT
 Accurate hourly Input & output is essential
 Notify HCP if no urine drainage for 1 hour
 Once caudal block wears off, acetaminophen or ibuprofen should be administered for pain
as ordered
 Antibiotics are usually prescribed until the urinary stent falls out or is removed
 Double diapering protects the stent
COMPLICATIONS
 Wound infection
 Dysuria (due to bladder spasms)
 Urethral stricture and obstruction
 Persistent chordee
 Persistent short length
 Urethral retraction and hypospadias
 Partial or complete penile loss

More Related Content

Similar to EPISPADIAS.pptx

Epispadias 131104120306-phpapp01 (1)
Epispadias 131104120306-phpapp01 (1)Epispadias 131104120306-phpapp01 (1)
Epispadias 131104120306-phpapp01 (1)
banubanu14
 
EPISPADIAS.pptx
EPISPADIAS.pptxEPISPADIAS.pptx
EPISPADIAS.pptx
Lawrenceshamboko
 
Ectopic ureter & ureterocoele
Ectopic ureter & ureterocoeleEctopic ureter & ureterocoele
Ectopic ureter & ureterocoele
GAURAV NAHAR
 
Urethral anomalies
Urethral anomaliesUrethral anomalies
Urethral anomalies
indumathibalakrishna
 
Anorectal malformation seminar
Anorectal malformation seminarAnorectal malformation seminar
Anorectal malformation seminar
Dr. Dixit
 
Hypospadias & epispadias
Hypospadias &  epispadiasHypospadias &  epispadias
Hypospadias & epispadias
ROMAN BAJRANG
 
Anorectal malformations.pptx
Anorectal malformations.pptxAnorectal malformations.pptx
Anorectal malformations.pptx
Pushpa Lal Bhadel
 
Anorectal malformations in children
Anorectal malformations in childrenAnorectal malformations in children
Anorectal malformations in children
dhanyav54
 
Epispadias exstrophy
Epispadias exstrophyEpispadias exstrophy
Epispadias exstrophy
anchal8203
 
Presentation1 3 (4).ppt
Presentation1 3 (4).pptPresentation1 3 (4).ppt
Presentation1 3 (4).ppt
ssuser8eb265
 
Management of Epispadia
Management of EpispadiaManagement of Epispadia
Management of Epispadia
Regi Septian
 
ANORECTAL MALFORMATIONS
ANORECTAL MALFORMATIONSANORECTAL MALFORMATIONS
ANORECTAL MALFORMATIONS
karrar adil
 
Undescended testes
Undescended testes Undescended testes
Undescended testes
racheetha
 
Anorectal malformations
Anorectal malformationsAnorectal malformations
Anorectal malformations
rahulverma1194
 
Congenital surgical diseases of urinary tract
Congenital surgical diseases of urinary tractCongenital surgical diseases of urinary tract
Congenital surgical diseases of urinary tract
Nayan Yadav
 
Congenital genito urinary disorders
Congenital  genito  urinary disordersCongenital  genito  urinary disorders
Congenital genito urinary disordersHelan Henna
 
Anatomy of kidney nd ureter copy
Anatomy of kidney nd ureter   copyAnatomy of kidney nd ureter   copy
Anatomy of kidney nd ureter copy
SnehaDaniel3
 
Congenital anomalies ppt
Congenital anomalies pptCongenital anomalies ppt
Congenital anomalies ppt
Mohammed Abd El Wadood
 

Similar to EPISPADIAS.pptx (20)

Epispadias
EpispadiasEpispadias
Epispadias
 
Epispadias 131104120306-phpapp01 (1)
Epispadias 131104120306-phpapp01 (1)Epispadias 131104120306-phpapp01 (1)
Epispadias 131104120306-phpapp01 (1)
 
EPISPADIAS.pptx
EPISPADIAS.pptxEPISPADIAS.pptx
EPISPADIAS.pptx
 
Ectopic ureter & ureterocoele
Ectopic ureter & ureterocoeleEctopic ureter & ureterocoele
Ectopic ureter & ureterocoele
 
Urethral anomalies
Urethral anomaliesUrethral anomalies
Urethral anomalies
 
Anorectal malformation seminar
Anorectal malformation seminarAnorectal malformation seminar
Anorectal malformation seminar
 
Hypospadias & epispadias
Hypospadias &  epispadiasHypospadias &  epispadias
Hypospadias & epispadias
 
Anorectal malformations.pptx
Anorectal malformations.pptxAnorectal malformations.pptx
Anorectal malformations.pptx
 
Anorectal malformations in children
Anorectal malformations in childrenAnorectal malformations in children
Anorectal malformations in children
 
Epispadias exstrophy
Epispadias exstrophyEpispadias exstrophy
Epispadias exstrophy
 
Presentation1 3 (4).ppt
Presentation1 3 (4).pptPresentation1 3 (4).ppt
Presentation1 3 (4).ppt
 
Management of Epispadia
Management of EpispadiaManagement of Epispadia
Management of Epispadia
 
ANORECTAL MALFORMATIONS
ANORECTAL MALFORMATIONSANORECTAL MALFORMATIONS
ANORECTAL MALFORMATIONS
 
Undescended testes
Undescended testes Undescended testes
Undescended testes
 
Anorectal malformations
Anorectal malformationsAnorectal malformations
Anorectal malformations
 
Congenital surgical diseases of urinary tract
Congenital surgical diseases of urinary tractCongenital surgical diseases of urinary tract
Congenital surgical diseases of urinary tract
 
Congenital genito urinary disorders
Congenital  genito  urinary disordersCongenital  genito  urinary disorders
Congenital genito urinary disorders
 
Anatomy of kidney nd ureter copy
Anatomy of kidney nd ureter   copyAnatomy of kidney nd ureter   copy
Anatomy of kidney nd ureter copy
 
Congenital anomalies ppt
Congenital anomalies pptCongenital anomalies ppt
Congenital anomalies ppt
 
Group 5
Group 5Group 5
Group 5
 

More from AminaRajah1

BREAST SURGERIES.pptx
BREAST SURGERIES.pptxBREAST SURGERIES.pptx
BREAST SURGERIES.pptx
AminaRajah1
 
BREAST SURGERIES.pptx
BREAST SURGERIES.pptxBREAST SURGERIES.pptx
BREAST SURGERIES.pptx
AminaRajah1
 
CIRCUMCISION.pptx
CIRCUMCISION.pptxCIRCUMCISION.pptx
CIRCUMCISION.pptx
AminaRajah1
 
INJURIES TO THE MALE AND FEMALE GENITALIA.pptx
INJURIES TO THE MALE AND FEMALE GENITALIA.pptxINJURIES TO THE MALE AND FEMALE GENITALIA.pptx
INJURIES TO THE MALE AND FEMALE GENITALIA.pptx
AminaRajah1
 
CRUSH INJURIES OF THE HAND.ppt
CRUSH INJURIES OF THE HAND.pptCRUSH INJURIES OF THE HAND.ppt
CRUSH INJURIES OF THE HAND.ppt
AminaRajah1
 
TEAM APPROACH TO WORK AMONG HEALTH CARE WORKERS.ppt
TEAM APPROACH TO WORK AMONG HEALTH CARE WORKERS.pptTEAM APPROACH TO WORK AMONG HEALTH CARE WORKERS.ppt
TEAM APPROACH TO WORK AMONG HEALTH CARE WORKERS.ppt
AminaRajah1
 
Microdactyly, macrodactyly and hemangioma.ppt
Microdactyly, macrodactyly and hemangioma.pptMicrodactyly, macrodactyly and hemangioma.ppt
Microdactyly, macrodactyly and hemangioma.ppt
AminaRajah1
 

More from AminaRajah1 (7)

BREAST SURGERIES.pptx
BREAST SURGERIES.pptxBREAST SURGERIES.pptx
BREAST SURGERIES.pptx
 
BREAST SURGERIES.pptx
BREAST SURGERIES.pptxBREAST SURGERIES.pptx
BREAST SURGERIES.pptx
 
CIRCUMCISION.pptx
CIRCUMCISION.pptxCIRCUMCISION.pptx
CIRCUMCISION.pptx
 
INJURIES TO THE MALE AND FEMALE GENITALIA.pptx
INJURIES TO THE MALE AND FEMALE GENITALIA.pptxINJURIES TO THE MALE AND FEMALE GENITALIA.pptx
INJURIES TO THE MALE AND FEMALE GENITALIA.pptx
 
CRUSH INJURIES OF THE HAND.ppt
CRUSH INJURIES OF THE HAND.pptCRUSH INJURIES OF THE HAND.ppt
CRUSH INJURIES OF THE HAND.ppt
 
TEAM APPROACH TO WORK AMONG HEALTH CARE WORKERS.ppt
TEAM APPROACH TO WORK AMONG HEALTH CARE WORKERS.pptTEAM APPROACH TO WORK AMONG HEALTH CARE WORKERS.ppt
TEAM APPROACH TO WORK AMONG HEALTH CARE WORKERS.ppt
 
Microdactyly, macrodactyly and hemangioma.ppt
Microdactyly, macrodactyly and hemangioma.pptMicrodactyly, macrodactyly and hemangioma.ppt
Microdactyly, macrodactyly and hemangioma.ppt
 

Recently uploaded

Top Effective Soaps for Fungal Skin Infections in India
Top Effective Soaps for Fungal Skin Infections in IndiaTop Effective Soaps for Fungal Skin Infections in India
Top Effective Soaps for Fungal Skin Infections in India
SwisschemDerma
 
How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
How STIs Influence the Development of Pelvic Inflammatory Disease.pptxHow STIs Influence the Development of Pelvic Inflammatory Disease.pptx
How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
FFragrant
 
Cardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdfCardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdf
shivalingatalekar1
 
BRACHYTHERAPY OVERVIEW AND APPLICATORS
BRACHYTHERAPY OVERVIEW  AND  APPLICATORSBRACHYTHERAPY OVERVIEW  AND  APPLICATORS
BRACHYTHERAPY OVERVIEW AND APPLICATORS
Krishan Murari
 
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Novas diretrizes da OMS para os cuidados perinatais de mais qualidadeNovas diretrizes da OMS para os cuidados perinatais de mais qualidade
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Prof. Marcus Renato de Carvalho
 
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAdv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS
AkankshaAshtankar
 
Top-Vitamin-Supplement-Brands-in-India List
Top-Vitamin-Supplement-Brands-in-India ListTop-Vitamin-Supplement-Brands-in-India List
Top-Vitamin-Supplement-Brands-in-India List
SwisschemDerma
 
Superficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptxSuperficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptx
Dr. Rabia Inam Gandapore
 
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness JourneyTom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
greendigital
 
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.GawadHemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
NephroTube - Dr.Gawad
 
Netter's Atlas of Human Anatomy 7.ed.pdf
Netter's Atlas of Human Anatomy 7.ed.pdfNetter's Atlas of Human Anatomy 7.ed.pdf
Netter's Atlas of Human Anatomy 7.ed.pdf
BrissaOrtiz3
 
Light House Retreats: Plant Medicine Retreat Europe
Light House Retreats: Plant Medicine Retreat EuropeLight House Retreats: Plant Medicine Retreat Europe
Light House Retreats: Plant Medicine Retreat Europe
Lighthouse Retreat
 
Thyroid Gland- Gross Anatomy by Dr. Rabia Inam Gandapore.pptx
Thyroid Gland- Gross Anatomy by Dr. Rabia Inam Gandapore.pptxThyroid Gland- Gross Anatomy by Dr. Rabia Inam Gandapore.pptx
Thyroid Gland- Gross Anatomy by Dr. Rabia Inam Gandapore.pptx
Dr. Rabia Inam Gandapore
 
Identification and nursing management of congenital malformations .pptx
Identification and nursing management of congenital malformations .pptxIdentification and nursing management of congenital malformations .pptx
Identification and nursing management of congenital malformations .pptx
MGM SCHOOL/COLLEGE OF NURSING
 
Physiology of Special Chemical Sensation of Taste
Physiology of Special Chemical Sensation of TastePhysiology of Special Chemical Sensation of Taste
Physiology of Special Chemical Sensation of Taste
MedicoseAcademics
 
SURGICAL ANATOMY OF THE RETROPERITONEUM, ADRENALS, KIDNEYS AND URETERS.pptx
SURGICAL ANATOMY OF THE RETROPERITONEUM, ADRENALS, KIDNEYS AND URETERS.pptxSURGICAL ANATOMY OF THE RETROPERITONEUM, ADRENALS, KIDNEYS AND URETERS.pptx
SURGICAL ANATOMY OF THE RETROPERITONEUM, ADRENALS, KIDNEYS AND URETERS.pptx
Bright Chipili
 
NVBDCP.pptx Nation vector borne disease control program
NVBDCP.pptx Nation vector borne disease control programNVBDCP.pptx Nation vector borne disease control program
NVBDCP.pptx Nation vector borne disease control program
Sapna Thakur
 
Role of Mukta Pishti in the Management of Hyperthyroidism
Role of Mukta Pishti in the Management of HyperthyroidismRole of Mukta Pishti in the Management of Hyperthyroidism
Role of Mukta Pishti in the Management of Hyperthyroidism
Dr. Jyothirmai Paindla
 
Non-respiratory Functions of the Lungs.pdf
Non-respiratory Functions of the Lungs.pdfNon-respiratory Functions of the Lungs.pdf
Non-respiratory Functions of the Lungs.pdf
MedicoseAcademics
 
Vision-1.pptx, Eye structure, basics of optics
Vision-1.pptx, Eye structure, basics of opticsVision-1.pptx, Eye structure, basics of optics
Vision-1.pptx, Eye structure, basics of optics
Sai Sailesh Kumar Goothy
 

Recently uploaded (20)

Top Effective Soaps for Fungal Skin Infections in India
Top Effective Soaps for Fungal Skin Infections in IndiaTop Effective Soaps for Fungal Skin Infections in India
Top Effective Soaps for Fungal Skin Infections in India
 
How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
How STIs Influence the Development of Pelvic Inflammatory Disease.pptxHow STIs Influence the Development of Pelvic Inflammatory Disease.pptx
How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
 
Cardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdfCardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdf
 
BRACHYTHERAPY OVERVIEW AND APPLICATORS
BRACHYTHERAPY OVERVIEW  AND  APPLICATORSBRACHYTHERAPY OVERVIEW  AND  APPLICATORS
BRACHYTHERAPY OVERVIEW AND APPLICATORS
 
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Novas diretrizes da OMS para os cuidados perinatais de mais qualidadeNovas diretrizes da OMS para os cuidados perinatais de mais qualidade
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
 
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAdv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS
 
Top-Vitamin-Supplement-Brands-in-India List
Top-Vitamin-Supplement-Brands-in-India ListTop-Vitamin-Supplement-Brands-in-India List
Top-Vitamin-Supplement-Brands-in-India List
 
Superficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptxSuperficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptx
 
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness JourneyTom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
 
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.GawadHemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
 
Netter's Atlas of Human Anatomy 7.ed.pdf
Netter's Atlas of Human Anatomy 7.ed.pdfNetter's Atlas of Human Anatomy 7.ed.pdf
Netter's Atlas of Human Anatomy 7.ed.pdf
 
Light House Retreats: Plant Medicine Retreat Europe
Light House Retreats: Plant Medicine Retreat EuropeLight House Retreats: Plant Medicine Retreat Europe
Light House Retreats: Plant Medicine Retreat Europe
 
Thyroid Gland- Gross Anatomy by Dr. Rabia Inam Gandapore.pptx
Thyroid Gland- Gross Anatomy by Dr. Rabia Inam Gandapore.pptxThyroid Gland- Gross Anatomy by Dr. Rabia Inam Gandapore.pptx
Thyroid Gland- Gross Anatomy by Dr. Rabia Inam Gandapore.pptx
 
Identification and nursing management of congenital malformations .pptx
Identification and nursing management of congenital malformations .pptxIdentification and nursing management of congenital malformations .pptx
Identification and nursing management of congenital malformations .pptx
 
Physiology of Special Chemical Sensation of Taste
Physiology of Special Chemical Sensation of TastePhysiology of Special Chemical Sensation of Taste
Physiology of Special Chemical Sensation of Taste
 
SURGICAL ANATOMY OF THE RETROPERITONEUM, ADRENALS, KIDNEYS AND URETERS.pptx
SURGICAL ANATOMY OF THE RETROPERITONEUM, ADRENALS, KIDNEYS AND URETERS.pptxSURGICAL ANATOMY OF THE RETROPERITONEUM, ADRENALS, KIDNEYS AND URETERS.pptx
SURGICAL ANATOMY OF THE RETROPERITONEUM, ADRENALS, KIDNEYS AND URETERS.pptx
 
NVBDCP.pptx Nation vector borne disease control program
NVBDCP.pptx Nation vector borne disease control programNVBDCP.pptx Nation vector borne disease control program
NVBDCP.pptx Nation vector borne disease control program
 
Role of Mukta Pishti in the Management of Hyperthyroidism
Role of Mukta Pishti in the Management of HyperthyroidismRole of Mukta Pishti in the Management of Hyperthyroidism
Role of Mukta Pishti in the Management of Hyperthyroidism
 
Non-respiratory Functions of the Lungs.pdf
Non-respiratory Functions of the Lungs.pdfNon-respiratory Functions of the Lungs.pdf
Non-respiratory Functions of the Lungs.pdf
 
Vision-1.pptx, Eye structure, basics of optics
Vision-1.pptx, Eye structure, basics of opticsVision-1.pptx, Eye structure, basics of optics
Vision-1.pptx, Eye structure, basics of optics
 

EPISPADIAS.pptx

  • 2. INTRODUCTION  Epispadias is a rare congenital malformation of the male or female urogenital organs that consists of a defect of the dorsal wall of the urethra.  In boys with epispadias, the urethra generally opens on the top or side of the penis rather than the tip.  However, it is possible for the urethra to be open along the entire length of the penis. In girls, the opening is usually between the clitoris and the labia but may be in the abdominal area.  Epispadias can be associated with bladder exstrophy.
  • 3. DEFINITION  Epispadias is a rare urogenital malformation characterized by the failure of the urethral tube to tubularize on the dorsal aspect.  Epispadias is an abnormality of the urethra in which the urethral opening is ectopically located on the dorsal aspect of the penis.
  • 4.
  • 5. INCIDENCE  Epispadias occurs in  one in 117,000 newborn boys  one in 484,000 newborn girls.  It is commonly seen as a component in the spectrum of bladder exstrophyepispadias- complex (BEEC).  Isolated epispadias constitutes less than 10 percent of the total cases of epispadias.  Isolated male epispadias is rare.
  • 6. ETIOLOGY  Epispadias can be explained by defective migration of the paired primordia of the genital tubercle that fuse on the midline to form the genital tubercle at the fifth week of embryologic development.  Epispadias is rarely observed in 2 members of the same family.
  • 8. FEMALE EPISPADIAS  Isolated female epispadias without bladder exstrophy is an extremely rare congenital anomaly.  The symptoms of female epispadias are primary urinary incontinence and abnormal anatomical features.  In females, epispadias consists of bifid clitoris with diastases of the corpora cavernosa, flattening of the mons, and separation of the labia.
  • 9. CLINICAL MANIFESTATION (MALE)  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
  • 10.
  • 11. CLINICAL MANIFESTATION (FEMALE)  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
  • 12. DIAGNOSIS  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
  • 13. SURGICAL MANAGEMENT  Surgical management of epispadias is challenging and requires technical expertise.  The surgery aims to reconstruct the genitalia and urethra, providing optimal functional and cosmetic outcomes.  At present, surgeons across the world have adopted either of the two following approaches:  Modified Cantwell-Ransley repair  Complete penile disassembly technique (Mitchell and Bagli)
  • 14. NURSING MANAGEMENT  Assess the newborns flow of urine, exit site, and angle of urination  Infant/child returns from surgery w/ penis wrapped in a simple dressing and a stent or catheter for  urinary drainage  Fresh blood may be seen on the dressing and in the stent or catheter in the immediate postop period, but the urine should become less bloody over the next few hours  Encourage fluid intake to maintain adequate urinary output and patency of the stent
  • 15. NURSING MANAGEMENT  Accurate hourly Input & output is essential  Notify HCP if no urine drainage for 1 hour  Once caudal block wears off, acetaminophen or ibuprofen should be administered for pain as ordered  Antibiotics are usually prescribed until the urinary stent falls out or is removed  Double diapering protects the stent
  • 16. COMPLICATIONS  Wound infection  Dysuria (due to bladder spasms)  Urethral stricture and obstruction  Persistent chordee  Persistent short length  Urethral retraction and hypospadias  Partial or complete penile loss