Hypospadias is a congenital defect where the opening of the urethra is on the ventral side of the penis rather than at the tip. It occurs in about 1 in 250 male newborns and is thought to result from arrested penile development leaving a proximal urethral opening. Treatment involves surgical repair to reposition the urethra, which depends on the location and severity of the hypospadias but generally aims to maximize function and cosmetic appearance. Complications can include bleeding, meatal stenosis and fistula formation.
Approximately 75% of abdominal wall hernias occur in the groin.
The lifetime risk of inguinal hernia is 27% in men and 3% in women.
And hence Of inguinal hernia repairs, 90% are performed in men, and 10% are performed in women.
The incidence of inguinal hernia in men has a distribution, with peaks before the first year of life and after age 40.
Indirect inguinal and femoral hernias occur more commonly on the right side.
This is attributed to a delay in atrophy of the processus vaginalis after the normal slower descent of the right testis to the scrotum during fetal development.
The predominance of right-sided femoral hernias is thought to be caused by the tamponading effect of the sigmoid colon on the left femoral canal
The prevalence of hernias increases and the likelihood of strangulation and need for hospitalization increase with aging.
Approximately 75% of abdominal wall hernias occur in the groin.
The lifetime risk of inguinal hernia is 27% in men and 3% in women.
And hence Of inguinal hernia repairs, 90% are performed in men, and 10% are performed in women.
The incidence of inguinal hernia in men has a distribution, with peaks before the first year of life and after age 40.
Indirect inguinal and femoral hernias occur more commonly on the right side.
This is attributed to a delay in atrophy of the processus vaginalis after the normal slower descent of the right testis to the scrotum during fetal development.
The predominance of right-sided femoral hernias is thought to be caused by the tamponading effect of the sigmoid colon on the left femoral canal
The prevalence of hernias increases and the likelihood of strangulation and need for hospitalization increase with aging.
In this presentation I have shown the etiology, clinical features and treatment for both Phimosis & Paraphimosis. I have also showed various methods of circumcision for both infants and adults.
Small intestine/Intestinal obstruction/crohns disease/ileostomy/viscous organ...RajeevPandit10
all about small intestine, anatomy, physiology, intestinal obstruction, crohns disease/ileostomy/viscous organ perforation, meckels diverticulum, mysenteric ischemia, short bowel syndrome, celiac disease
Rectal prolapse (Surgical anatomy of rectum, pathology and management0sunil kumar daha
Please find the powerpoint on Rectal prolapse. I tried present it on understandable way and all the contents are reviewed by experts and from very reliable references.
In this presentation I have shown the etiology, clinical features and treatment for both Phimosis & Paraphimosis. I have also showed various methods of circumcision for both infants and adults.
Small intestine/Intestinal obstruction/crohns disease/ileostomy/viscous organ...RajeevPandit10
all about small intestine, anatomy, physiology, intestinal obstruction, crohns disease/ileostomy/viscous organ perforation, meckels diverticulum, mysenteric ischemia, short bowel syndrome, celiac disease
Rectal prolapse (Surgical anatomy of rectum, pathology and management0sunil kumar daha
Please find the powerpoint on Rectal prolapse. I tried present it on understandable way and all the contents are reviewed by experts and from very reliable references.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
2. DEFINITION
• Hypospadias is defined as hypoplasia of
the tissues forming the ventral aspect of
the penis beyond the division of the
corpus spongiosum.
• Hypospadias is believed to result from
arrested penile development, leaving a
proximal urethral meatus.
3. • Incidence- 1/250 male newborns
• Association of 3 anomalies
Abnormal ventral opening of urethral
meatus
Abnormal ventral curvature of the penis
Abnormal distribution of foreskin with a
dorsal hood
4. DIAGNOSIS
• Hypospadias is diagnosed by physical examination, first
suspected by the ventrally deficient prepuce and confirmed
by the proximal meatus.
5. • Abnormal ventral findings potentially
include
1. Downward glans tilt,
2. Deviation of the median penile raphe,
3. Ventral Curvature,
4. Scrotal encroachment onto the penile
shaft,
5. Midline scrotal cleft, and
6. penoscrotal transposition.
6. NORMAL PENILE ANATOMY
2 Corpora Cavernosa, Corpus Spongiosum
Enclosed InAFascial Sheath- T.Albuginea
Bucks Fascia, Thick Fibrous Envelope
7. Embryology of Penile Development
• The external genital anlage is initially indifferent
and develops the female phenotype unless
exposed to androgens during the critical
gestational time period of 8 to 12 weeks.
• The urethral plate develops as an extension of
endoderm from the cloaca along the ventral
midline of the genital tubercle.
9. • Proliferating mesenchyme to either side creates
urethral folds and establishes the urethral groove.
• Fusion of the urethral folds begins proximally and
continues distally at least to the glans.
• Two theories are proposed for glanular urethra
development: ectodermal ingrowth cannulating the
glans to the urethral plate versus urethral plate
tubularization to the tip of the glans.
10.
11.
12. ETIOLOGY
Genetic Factors
• Familial aggregation is found in 4% to 10% of
hypospadias cases, including first-, second-, and third-
degree relatives.
Gene Mutations
• Murine studies indicating androgen receptor activity
regulates Fgf8, Fgf10, and Fgfr2 involved in urethral
development have led to screening for defects in these
candidate genes in patients with hypospadias.
13. ETIOLOGY
In most cases, the cause of this congenital defect is not
fully understood.
Treatment with hormones such as progesterone during
pregnancy may increase the risk of hypospadias.
Certain hormonal fluctuations, such as failure of the
fetal testes to produce enough testosterone or the
failure of the body to respond to testosterone, increase
the risk of hypospadias and other genetic problems.
17. The cosmetic indications, which are strongly linked
patient’s future psychology, are:
1. Abnormally located meatus
2. Cleft glans
3. Rotated penis with abnormal cutaneous raphe
4. Preputial hood
5. Penoscrotal transposition
6. Split scrotum.
18. Pre operative Consideration
Timing of surgery:
• Performed between 6 and 12 months.
• Healing seems to occur more quickly and with fewer
scars, and young infants overcome the stress of surgery
more easily.
• This age seems to insulate most children form the
psychologic, physiologic, and anaesthetic trauma
associated with hypospadias surgery.
19.
20. Preoperative Hormonal Stimulation:
HCG 250-500 U sc twice a week for 3 weeks. Increase in penile
size and length
Decrease in hypospadias and chordee severity
Increased vascularity and thickness of corpus spongiosum
Allowance of more simple repairs
IM testosterone enanthate – 2mg/kg/dose given for a total of 2
or 3 doses before hypospadias repair
Testosterone propionate cream – 2% three times daily for 3
weeks
21. GENERAL PRINCIPLES OF
HYPOSPADIAS REPAIR
ORTHOPLASTY
Correction of ventral
curvature
URETHROPLASTY
MEATOPLASTY GLANULOPLASTY
SKIN COVERAGE
22.
23. Serafeddin (15TH century) was a surgeon from central Antolia
during the Ottoman period.
• In one of his books he describes the fine scalpel “mibza”
used for the treatment of meatal stenosis in hypospadias.
24. ORTHOPLASTY
• Correction of ventral curvature
• Ventral tissues—including shaft skin, dartos,
corpus spongiosum, urethral plate, and
overlying tunics of the corpora cavernosa may
be shortened relative to the dorsal surface.
• VC occurred in 11% of primary distal cases,
30% midshaft, and 81% proximal hypospadias.
25. • Preoperative assessment cannot accurately predict
either the extent of curvature or the means required for
straightening.
• Intraoperative assessment of penile curvature by either
artificial or pharmacologic methods is a critical step in
hypospadias repair.
• Performed after degloving of penile shaft skin.
26.
27.
28. • Artificial erection induced by saline injection remains
the most commonly used means to assess presence and
severity of VC.
• Pharmacologic erection allows for a more accurate and
continued assessment of penile curvature before,
during, and after its correction.
• Intracorporal injection of the arterial vasodilator
prostaglandin E1.
29. • Curvature up to 30
degrees can be corrected
by Midline Dorsal
Plication into the tunica
albuginea of the corpora
cavernosa directly
opposite the area of
greatest bending.
30. Nesbit technique :
• Excision of diamond
shaped wedge/s at the
point of maximum
curvature and closing the
tunica transversely with
absorbable sutures.
33. URETHROPLASTY
Distal hypospadias :
• TIP repair
• Others like MAGPI, Mathieu flip-flap, and Urethral
advancement.
Midshaft hypospadias :
• TIP repair
• Onlay preputial flap
34. Proximal hypospadias :
• TIP repair
• Onlay preputial flap
• Single stage urethroplasty with preputial flap or the
Koyanagi flap.
• Two stage repair with Byars flaps or grafts.
35.
36. Distal Hypospadias
Tubularized incised plate (TIP) repair:
• Circumscribing incision is made approximately 2 mm
below meatus
• Ventral V incision
• Penis degloved
• Midline incision of the urethral plate
• Urethral plate tubularization begins distally
approximately 3 mm from the end of the plate, ensuring
an oval, not rounded, meatus.
37.
38. • Dartos flap is dissected from the dorsal prepuce and shaft
skin, buttonholed, and transposed ventrally to cover the
neourethra.
• Glansplasty begins distally, and a 7-0 polyglactin suture.
39. Midshaft Hypospadias
TIP repair
Onlay preputial flap :
• Thin skin proximal to the urethral meatus is incised to the
midline convergence of corpus spongiosum wings.
• Then inner prepuce is harvested on its vascular pedicle from
either the dorsal hood or dartos flap.
• The flap should be gently stretched to fit the urethral plate
without redundancy.
40.
41.
42. Proximal Hypospadias
• The greatest controversy in primary hypospadias surgery
concerns decision making for proximal cases.
• Options depend on whether the urethral plate is available for
urethroplasty after associated VC is straightened.
• If so, then either TIP repair or an onlay preputial flap can be
used.
• When the urethral plate is transected a one-stage
urethroplasty can be accomplished by tubularized preputial
flaps or the Koyanagi flap or a two-stage repair done with
Byars flaps or preputial grafts.
43. Proximal tubularized incised plate repair :
• Circumscribing incision preserves urethral plate in patient desiring
circumcision.
• After degloving, glans wings are separated from the urethral
plate.
• Corpus spongiosum is dissected from the cavernosal bodies
• Midline urethral plate incision.
• Spongioplasty over the neourethra.
46. Koyanagi flap
• Proposed lines of incisions to create flap
• The flap can be divided into two wings as shown or
maintained in one piece with a central buttonhole to
transpose it ventrally.
47. • The urethral plate in the center of the flap is dissected from
the corpora to near the meatus, and the glanular portion of
the plate is excised as glans wings are made.
48. • Inner flap margins are
reapproximated, and excess
flap skin is excised.
• The outer margins are closed
to complete tubularization
49. Byars flap
• After degloving and release of ventral dartos,
persisting ventral curvature greater than 30
degrees led to excision of the urethral plate.
• The dorsal preputial hood is incised in the
midline and the two flaps transposed
ventrally on either side of the penis.
• The prepuce is advanced into the glans;
alternatively, the urethral plate can be
maintained within the glans.
50. • Flap edges are
approximated in the
midline.
• Six months later a U-
shaped incision is made
approximately 10 mm
wide.
55. • Epispadias is a congenital malformation in
which the opening of the urethra is on the
dorsum of the penis.
• 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
belly area.
57. Causes
• Unknown
• Related to improper development of the pubic
bone
• Failures of abdominal and pelvic fusion in the
first months of embryogenesis
• Epispadias can be associated with bladder
exstrophy, an uncommon birth defect in which
the bladder is inside out, and sticks through the
abdominal wall
• Also occur with other defects
58. Classification
Classification of epispadias is based on the
location of the meatus the penis. It can be
positioned:
• On the glans (glanular)
• Along the shaft of the penis (penile)
• Near the pubic bone (penopubic).
59. • The position of the meatus is important
because it predicts the degree to which
the bladder can store urine (continence).
The closer the meatus is to the base of the
penis, the more likely the bladder will not
hold urine
60. Symptoms
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
61. In females:
• Abnormal clitoris and labia
• Abnormal opening where the 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 infection
62. Diagnostic measures
• Prenatal diagnosis - rare
• 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
63. Surgical technique in males:
• The modified Cantwell technique
It involves partial disassembly of the
penis and placement of the urethra in a
more normal position.
64. Treatment
The primary goals of treatment of epispadias are to:
• maximize penile length and function by correcting
dorsal bend and chordee; and
• create functionality and cosmetically acceptable
external genitalia with as few surgical procedures as
possible.
• If the bladder and bladder neck are also involved,
surgical treatment is required to establish urinary
continence and preserve fertility.
65. • The second technique is the Mitchell technique.
»It involves complete disassembly of
the penis into its three separate
components.
»Following disassembly, the three
components are reassembled such
that the urethra is in the most
functional and normal position
and dorsal chordee is corrected.
66. Surgical technique in females
• The urethra and vagina may be short and near
the front of the body and the clitoris is in two
parts.
• If diagnosed at birth, the two parts of the clitoris
can be brought together and the urethra can be
placed into the normal position.
• If repaired early enough, lack of urinary control
(incontinence) may not be a problem.
67. • If the diagnosis is missed or if early repair
is not performed, then incontinence can be
surgically corrected at the time of
diagnosis.
• If the vaginal opening is narrow in older
girls or younger women, reconstruction
can be performed after puberty.
68. Take home message
• Hypospadias – ectopic ventral opening of the
meatus
• Associations- chordee and hernia
• Dorsal hood of foreskin, glanular groove with
ventral incomplete prepuce
• Circumcision contraindicated
• Surgery- 4 to 18 months