EPISPADIAS (CONGENITAL ANOMALY OF GENITOURINARY SYSTEM)

CONGENITAL ANOMALY OF GENITOURINARY SYSTEM. BY MR. DINABANDHU BARAD

1. Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU

2. CONGENITAL ANOMALY OF GENITOURINARY SYSTEM Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU BY: Dinabandhu Barad MSC TUTOR, SNC,SOA,DTU

3. EPISPADIASIS Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU

4. 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. Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU EPISPADIASIS

5. ETIOLOGY There are several etiological factors have been proved to be strongly associated with Hypospadias. few of them are as follows : Genetic Endocrine environmental factors. Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU

6. 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 Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU

7. CLASSIFICATION Classification of epispadias is based on the location of the meatus the penis. It can be positioned: ANTERIOR EPISPADIAS WITH NORMAL CONTINENCE On the glans ( glanular ) Along the shaft of the penis (penile) B. POSTERIOR EPISPADIAS ASSOCIATED WITH INCOMPLETE BLADDER NECK AND INCONTINENCE OF URINE Near the pubic bone ( penopubic ). Sub symphyseal Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU

8. CLASSIFICATION CLASSIFICATION OF EPISPADIAS IS BASED ON THE LOCATION OF THE MEATUS IN FEMALE Bifid clitoris with no incontinence of urine Subsymphyseal with incontinence of urine Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU

9. • 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 Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU EPISPADIASIS

10. 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 Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU

11. 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 Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU SYMPTOMS

12. 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 Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU

13. T R E A T M E N T 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. Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU

14. SURGERY Management of epispadias is done by the surgical correction usually in three stages: First stage of surgery is done in about 1.5 to 2 years of age for penile lengthening Elongation of the urethral strip Chordee correction Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU

15. SURGERY Management of epispadias is done by the surgical correction usually in three stages: 2. Second stage operation is done at least 6 months after the first stage surgery for urethral reconstruction Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU

16. SURGERY Management of epispadias is done by the surgical correction usually in three stages: 3. The third stage surgery is done about 3-4 years of age for bladder neck reconstruction . Cystoplasty can be done to enhance the bladder capacity after 2-3 years of 3 rd stage surgery . Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU

17. NURSING CARE Prevention of infection Emotional support for long-term management Routine pre and post operative management Health maintenance Promotion of growth and development by balance diet Immunization Hygienic measures Parental guidance Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU

18. THANK YOU