Epispadias

Subject: Midwifery III (Theory)

Overview

An epispadias is a rare type of penis malformation in which the urethra terminates in an opening on the upper aspect (the dorsum) of the penis. It can also occur in females when the urethra develops too far anteriorly. It occurs in approximately 1 in 120,000 male and 1 in 500,000 female births. Epispadias is a rare and partial form of the exstrophy - epispadias complex, which is characterized by failures of abdominal and pelvic fusion during the first months of embryogenesis. It occurs around the fifth week of gestation as a result of defective migration of the genital tubercle primordia to the cloacal membrane, resulting in genital tubercle malformation.

Epispadias is a rare type of penis malformation in which the urethra terminates in an opening on the upper aspect (the dorsum) of the penis. It can also occur in females when the urethra grows too far anteriorly. It occurs in approximately 1 in 120,000 male births and 1 in 500,000 female births.

Causes:

Epispadias is a rare and partial form of the exstrophy - epispadias complex, which is characterized by failures of abdominal and pelvic fusion during the first months of embryogenesis. While epispadias is present in all cases of exstrophy, it can also appear as the least severe form of the complex spectrum on its own. It occurs around the 5th week of gestation as a result of defective migration of the genital tubercle primordia to the cloacal membrane, resulting in genital tubercle malformation.

At birth, hypospadias is present. The exact cause of this flaw is unknown. Hypospadias can be inherited. Certain hormones stimulate the formation of the urethra and foreskin in a male fetus as the penis develops. Hypospadias occurs when the action of these hormones fails, causing the urethra to develop abnormally.

Signs and symptoms:

Opening of the urethra other than at the tip of the penis.
The penis has a downward curve (chordee).
Because only the top half of the penis is covered by the foreskin, the penis appears hooded.
Unusual spraying while urinating

Diagnosis:

A physical examination is used to diagnose hypospadias.
A sex-determination evaluation may be performed in cases of severe hypospadias, such as the absence of testicles in the scrotum.

Treatment:

The primary treatment for isolated epispadias is a comprehensive surgical repair of the genito-urinary area, typically performed during the first 7 years of life, which includes reconstruction of the urethra, closure of the penile shaft, and corpora mobilization. The modified Cantwell-Ransley approach is the most widely used and successful technique. However, despite its association with a higher and more serious risk of damage, the complete penile disassembly technique has seen increasing success in recent decades.

Things to remember

Epispadias is a rare type of penis malformation in which the urethra terminates in an opening on the upper aspect (the dorsum) of the penis.
It can also occur in females when the urethra grows too far anteriorly.
It occurs in approximately 1 in 120,000 male births and 1 in 500,000 female births.
Epispadias is a rare and partial form of the exstrophy - epispadias complex, which is characterized by failures of abdominal and pelvic fusion during the first months of embryogenesis.
It occurs around the 5th week of gestation as a result of defective migration of the genital tubercle primordii to the cloacal membrane, resulting in genital tubercle malformation.
A sex-determination evaluation may be performed in cases of severe hypospadias, such as the absence of testicles in the scrotum.
The primary treatment for isolated epispadias is a comprehensive surgical repair of the genito-urinary area, typically performed during the first 7 years of life, which includes reconstruction of the urethra, closure of the penile shaft, and corpora mobilization.
The modified Cantwell-Ransley approach is the most widely used and successful technique.

Questions and Answers

Define epipadias ?

The urethra ends in an opening on the upper aspect (the dorsum) of the penis in an epispadias, a rare type of penis malformation. When the urethra grows too much anteriorly in females, it may also manifest. About 1 in 120,000 male and 1 in 500,000 female births are affected by it.

List the Signs and symptoms of hypospadias ?

Signs and symptoms of hypospadias may include:

Opening of the urethra anywhere other than the penile tip
The penis is curved downward (chordee)
Because the foreskin only covers the top half of the penis, the penis appears hooded.
Abnormal urination with spraying

What are the causes of Epispadias ?

The exstrophy - epipadias complex, which includes a variety of failures of abdominal and pelvic fusion in the early stages of embryogenesis, includes epispadias as a rare and incomplete type. Although epispadias is a condition that occurs in every incidence of exstrophy, it can also, though much less commonly, manifest alone as the mildest version of the complex spectrum. It happens around the fifth week of pregnancy as a result of improper migration of the genital tubercle primordii to the cloacal membrane, which results in deformity of the genital tubercle. At birth, hypospadias is present (congenital). There is no known cause for this issue. Hypospadias can occasionally be inherited. A male fetus's foreskin and urethra form as the penis develops, in response to particular hormones. When a child is born with a malfunction occurs in the action of these hormones, causing the urethra to develop abnormally.