Epispadiasis

Epispadiasis

1. Epi spadiasis Ratheesh.R SLMGNC

2. Introduction: An  epispadias  is a rare type of malformation of the penis in which the urethra ends in an opening on the upper aspect (the dorsum) of the penis. It can also develop in females when the urethra develops too far anteriorly .

3. Definition: It is a rare congenital condition in which the Urethral Meatus opens dorsally on top of the penis, proximal to the glans . Incidence – 1 in 120,000 male and 1 in 500,000 female births. Occurance – More common in male than in girls.

4. Etiology: Unknown Inguinal hernia Male siblings Improper development of the pubic bone Birth Defect Other Genito urinary defects.

5. Clinical Manifestation: 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

6. Cont…. In females : Abnormal clitoris and labia Abnormal opening 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 infections

7. Diagnostic Findings: History Collection Physical Examination 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

8. Treatment: Surgical repair of epispadias is recommended in patients with more than a mild case .  

9. Cont…. After surgery: Depending on the extent of surgery, the child may either go home the same day or stay in the hospital overnight. The Children's nurses will talk with, how to care for him at home and will provide detailed instruction sheets (how to manage his dressing, what activities should be avoided, etc.)

10. Cont…. For the child's recovery period, the doctor may prescribe any or all of the following: Acetaminophen (Tylenol), to help ward off soreness in the first few days after surgery Antibiotic ointment, to be applied to the penis several times a day Oral antibiotics Antispasmodic medication, to alleviate bladder spasms

11. Nursing Diagnosis: Pain r/t surgical incision and drainage tube. Risk for infection r/t surgical incision and drainage tube. Body image disturbance r/t Appearance of genitalia. Impaired urinary elimination r/t the condition and surgical intervention. Risk for fluid volume deficit r/t surgical losses.

12. Complication: Abnormal opening from the bladder neck to the area above the normal urethra opening. Backward flow of urine into the kidney (reflux nephropathy) Urinary incontinence. Urinary tract infections. Widened pubic bone.