Epispadias is a rare urological condition that is present at birth. The urinary tract is affected and the way that urine exits the body is altered.
Both boys and girls can be born with Epispadias. However, boys are affected more often than girls. There are many types of Epispadias Repair Surgery to fix the problem.
The urinary tract has two kidneys, two ureters, the urethra and bladder. The kidneys filter out toxins, but keep salts, sugar, proteins and minerals. The waste product is known as urine. It’s made in the kidneys, goes down two tubes called ureters and is pushed into the bladder. The path closes so the urine can’t flow back to the kidneys. When it’s time to release urine out of the body, it’s carried from the bladder by a tube called the urethra.
How It Affects Boys
Epispadias affects 1 in 117,000 boys. Normally, the urethra opening is at the tip of the penis. With Epispadias, it’s on top of the penis.
There are 3 types of Epispadias in boys. It’s classified based on the location of the urethra on the penis.
- Glandular Epispadias – on the head of the penis
- Penile Epispadias – along the shaft of the penis
- Penopubic Epispadias – near the pubic bone
Depending on the position of the urethra, it predicts how well the urine is stored in the bladder. If it’s close to the abdominal wall, base of the penis, it probably won’t hold urine because the bladder sphincter is affected.
How It Affects Girls
Epispadias affects 1 in 484,000 girls, so it’s very rare.
When the baby girl is born, the pubic bones are separated into two different degrees, making the clitoris split down the middle. The bladder neck is usually affected.
When she coughs or with strenuous effort, she is likely to leak urine.
Before Epispadias Repair Surgery
After a diagnosis of Epispadias, tests are done to check the urinary tract, colon, pelvis and abdomen for other defects. With these tests, the nature of the problem is determined and a surgical treatment course is dictated.
If areas, such as the bladder are exposed, when it’s usually covered by skin, the procedure to close it up is usually performed while the child is still a newborn.
Due to the wide variety of issues that can be present with Epispadias, the treatment plan is unique with each child.
Treatment Options For Boys
The treatment goals are:
- Fix penis bends
- Make the penis look normal
- Make the penis a good length
- Make sure the penis works
- If the bladder and it’s neck are affected, surgery will be needed so the child can control the urine
- To preserve fertility, surgery might be needed
There are two Epispadias Repair Surgeries that can be done on boys, Mitchell Technique and Modified Cantwell Technique.
If Mitchell Technique is done, the surgeon will completely take the penis apart and put it back together. He makes sure that the dorsal band is connected and the urethra is in the most normal and functional position.
The Modified Cantwell Technique is used to rebuild the penis. Some of the penis is taken apart to move the urethra to a better position.
Treatment Options For Girls
If the baby girl is diagnosed at birth, the clitoris can be brought together and the urethra can be put in its normal position. Lack of urinary control might not happen.
The girls reconstruction is less complex than boys. The ovaries, Fallopian tubes and uterus are usually normal.
Typically, patients undergoing Epispadias Repair Surgery recovers very quickly.