Hypospadias & epispadiasis

Nursing

1. Hypospadias
Justin v sebastian

2. •Hypospadias is a birth defect (congenital
condition) in which the opening of the urethra is
on the underside of the penis instead of at the tip.
•Hypospadias is common and doesn't cause
difficulty in caring for infant. Surgery usually
restores the normal appearance of child's penis.
With successful treatment of hypospadias, most
males can have normal urination and
reproduction.

3. Causes
Hypospadias is present at birth (congenital).
As the penis develops in a male fetus, certain
hormones stimulate the formation of the
urethra and foreskin. Hypospadias results
when a malfunction occurs in the action of
these hormones, causing the urethra to
develop abnormally.

4. Risk factors
Although the cause of hypospadias is usually unknown, these factors may be
associated with the condition:

• Family history. This condition is more common in infants with a family
history of hypospadias.

• Genetics. Certain gene variations may play a role in disruption of the
hormones that stimulate formation of the male genitals.

• Maternal age over 35. Some research suggests that there may be an
increased risk of hypospadias in infant males born to women older than 35
years.

• Exposure to certain substances during pregnancy. There is some
speculation about an association between hypospadias and a mother's
exposure to certain hormones or certain compounds such as pesticides or
industrial chemicals, but further studies are needed to confirm this.

5. PATHOPHYSIOLOGY
Due to incomplete fusion of urethral folds
along the midline
Severity of condition depends on the
location of opening
➢ The presence of opening near glans is
known as Glandular Hypospadias
➢Presence of opening at corona is known as
Coronal Hypospadias.

6. CONT……………….
➢ Presence of opening at shaft is
known as Penile Hypospadias.
➢ Opening at junction of penis and
scrotum is known as Penoscrotal
Hypospadias
➢ Presence of opening at perineum is
known as Perineal Hypospadias

8. Symptoms
In hypospadias, the opening of the urethra is located on the underside
of the penis instead of at the tip. In most cases, the opening of the
urethra is within the head of the penis. Less often, the opening is at
the middle or the base of the penis. Rarely, the opening is in or
beneath the scrotum.
Signs and symptoms of hypospadias may include:

• Opening of the urethra at a location other than the tip of the penis

• Downward curve of the penis (chordee)

• Hooded appearance of the penis because only the top half of the
penis is covered by foreskin

• Abnormal spraying during urination

9. Complications
If hypospadias is not treated, it can result in:

• Abnormal appearance of the penis

• Problems learning to use a toilet

• Abnormal curvature of the penis with
erection

• Problems with impaired ejaculation

10. Diagnosis
•Child's pediatrician can diagnose hypospadias based on
a physical exam. He or she will likely refer to a surgeon
who specializes in genital and urinary conditions
(pediatric urologist) for further evaluation.

11. Treatment
•Some forms of hypospadias are very minor and do not
require surgery. However, treatment usually involves
surgery to reposition the urethral opening and, if
necessary, straighten the shaft of the penis. Surgery is
usually done between the ages of 6 and 12 months.

12. Surgery
•Most forms of hypospadias can be corrected in a single surgery that's done on an
outpatient basis. Some forms of hypospadias will require more than one surgery
to correct the defect.
•When the urethral opening is near the base of the penis, the surgeon may need to
use tissue grafts from the foreskin or from the inside of the mouth to reconstruct
the urinary channel in the proper position, correcting the hypospadias.
Results of surgery
•In most cases, surgery is highly successful. Most of the time the penis looks
normal after surgery, and boys have normal urination and reproduction.
•Occasionally, a hole (fistula) develops along the underside of the penis where the
new urinary channel was created and results in urine leakage. Rarely, there is a
problem with wound healing or scarring. These complications may require an
additional surgery for repair.

13. Epispadias
Justin V Sebastian

14. Epispadias is a rare congenital (present at
birth) abnormality that involves the
opening of the urethra (the tube from
which urine exit the bladder). In boys with
epispadias, the urethra opens in top of the
penis rather than the tip.

15. How Does Epispadias Affect Boys?
Epispadias is quite rare, affecting only 1 in 117,000 males.
The epispadias is classified based on the location of the
meatus on the penis.
▪Glanular epispadias: It is found on the head of the penis
▪Penile epispadias: It is found along the shaft of the penis
▪Penopubic epispadias: it is found or near the pubic bone

16. Causes
•The causes of epispadias are not known. It may occur
because the pubic bone does not develop properly.
•Epispadias can occur with a rare birth defect called
bladder exstrophy. In this birth defect, the bladder is
open through the wall of the abdomen.
•Epispadias can also occur with other birth defects.

17. Symptoms
•Males will have a short, wide penis with an
abnormal curve.
•The urethra most often opens on the top or side
of the penis instead of the tip. However, the
urethra may be open along the whole length of
the penis.

18. Exams and Tests
Signs include:
•Backward flow of urine into the kidney (reflux nephropathy,
hydronephrosis)
•Urinary incontinence
•Urinary tract infections
•Widened pubic bone
Tests may include:
•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 urinary system and genitals

19. Treatment. Surgical repair of epispadias is
recommended in patients with more than a mild
case. Leakage of urine (incontinence) is not
uncommon and may require a second operation.
Surgery generally leads to the ability to control
the flow of urine and a good cosmetic outcome.

20. Nursing Diagnosis
1.Acute Pain May be related to Surgery
•Assess location, characteristics, onset, duration,
frequency, location, and severity of pain; Observe
for verbal and nonverbal cues.
•Maintain a position of comfort; Properly set the
catheter to avoid tension
•Administer analgesic (e.g., Tylenol) as ordered.
•Educate parents that medications will prevent pain
and restlessness and allow for healing.

21. Nursing Diagnosis
2.Impaired Urinary Elimination May be related to Mechanical
trauma from surgery (urethroplasty)
•Record input and output; Assess voiding stream, color and
amount of urine on first flow of urine and each succeeding
void.
•Encourage high fluid intake after catheter removed, offer
favoured choice of liquids hourly.
•Support child after the catheter is removed and provide
privacy for voiding.
•Instruct parents to notify the physician of changes in the
urinary pattern or inability to void.

22. Nursing Diagnosis
3.Anxiety May be related to Change in health status or Change
in environment
•Assess source and level of anxiety and need for information
that will relieve anxiety.
•Encourage verbalization of concerns and allow time for
parents and child to ask questions about condition, procedures,
recovery.
•Encourage parents to stay with the child during
hospitalisations and to assist in care.
•Answer questions calmly and honestly; use pictures, drawings,
and models for information.

23. Nursing Diagnosis
3.Risk for Infection May be related to Inadequate primary
defences (surgical incision), Invasive procedure (catheter)
•Assess wound for redness, swelling, drainage on dressing.
•Observe catheter insertion site for redness, irritation,
swelling; Monitor urine in the catheter bag for cloudiness,
foul odor, sediment.
•Obtain urine specimen for culture and sensitivities as
indicated.
•Apply sterile technique during dressing changes, catheter
care or draining urine bag.