Epispadias is a rare congenital abnormality that involves the opening of the urethra. It can occur in male as well as in female.
In Male – The urethra opens in the top of the penis rather than the tip.
In Female – The urethral opening is towards the clitoris or even in the belly area.
Frequency – It occurs more commonly in males than in females, with a prevalence of 1 case in 10,000 – 50,000 persons.
The male to female ratio is 2.3 : 1
Etiology – There are more than one hypothesis about epispadias.
1. Defective migration of paired primordia of the genital tubercle that usually fuse on the midline to form the genital tubercle at the fifth week of embryonal development.
2. Another hypothesis relates the defect to the abnormal developement of the cloacal membrane.
Classification – Usually Epispadias are of three types.
1. Glandular – Malformation affects the distal part of the urethra.
2. Penile – Entire penile urethra is affected, with an external meatus on the dorsal shaft of the penis.
3. Complete or Penopubic type – total deficiency of the dorsal wall of the urethra.
How epispadias are diagnosed ?
Epispadias is most often noticed at birth during physical examination. If the defect is mild, it might not be detected at first.
In some cases, it might not be noticed until the child has been toilet trained and presents with urine leak. This is most common eith girls.
Treatment – Surgery is the treatment of choice for epispadias.
The main goals of the treatment are –
1. Make sure the penis works properly
2. Make the penis of a good length.
3. Fix bends in the penis ( dorsal bend and chordae)
4. Make the penis look normal
5. If the bladder and bladder neck are affected, surgery will be needed to make sure that the child can control his urine
6. Surgery might also be needed to preserve fertility.