hypospadias AND epispadias .pptx

hypospadias AND epispadias in children

1. HYPOSPADIAS AND EPISPADIAS PRESENTED BY: M.C.KNIRANDA ASSISTANT PROFESSOR SSNSR, SU.

2. Hypospadias Normal opening

3. • 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. DEFINITION

4. Causes The exact cause of hypospadias in infants is usually unknown , but it's likely caused by a combination of genetic and environmental factors during pregnancy. 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. (Like reduced testosterone levels , elevated oestrogen levels may also be a risk factor for hypospadias)

5. Risk factors Although the cause of hypospadias is usually unknown, these factors may be associated with the condition: Family history. Maternal age over 35. Maternal Smoking Low birth weight or preterm babies Use of assisted reproductive technology or fertility treatments during pregnancy may increase the risk Exposu r e t o certai n substance s durin g pregnancy such as pesticides or industrial chemicals, but further studies are needed to confirm this.

6. Types of Hypospadias Glandular Hypospadias - The presence of opening near glans. Coronal Hypospadias - Presence of opening at corona. Penile Hypospadias - Presence of opening at shaft. Penoscrotal Hypospadias - Opening at junction of penis and scrotum Perineal Hypospadias - Presence of opening at perineum

7. Symptoms 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 CHORDEE

8. Complications If hypospadias is not treated, it can result in: Abnormal appearance of the penis Problems learning to use a toilet Abnor ma l c urv at ure of t he p e n i s w it h erection Problems with ejaculation

9. Diagnosis P hysical exam ination . Any history of a familial pattern of hypospadias A history of parental difficulties in conceiving and treatment. In some cases, an ultrasound can diagnose severe hypospadias before birth.

10. 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 .

11. Treatment Hypospadias surgery , also known as hypospadias repair , is a procedure that can treat hypospadias in children. The surgery can be a one- or two-stage procedure , depending on the severity of the hypospadias. Most pediatric urologists recommend performing the surgery when the child is between 6 and 12 months old. At this age, it's easier to care for the surgery site and safer for the child to have general anesthesia.

12. HYPOSPADIAS REPAIR Before surgery, the child will receive general anesthesia . Mild defects may be repaired in one procedure. Severe defects may need two or more procedures. The surgeon will use a small piece of foreskin or tissue from another site to create a tube that increases the length of the urethra . Extending the length of the urethra will allow it to open at the tip of the penis. During surgery, the surgeon may place a catheter (tube) in the urethra to make it hold its new shape. The catheter may be sewn or fastened to the head of the penis to keep it in place. It will be removed 1 to 2 weeks after surgery . Most of the stitches used during surgery will dissolve on their own and will not have to be removed later.

13. FEMALE HYPOSPADIAS Female hypospadias is an extremely rare congenital abnormality that causes the urethra to shorten and the urethral opening to be located on the anterior vaginal wall, close to the introitus . It can cause a variety of symptoms, including : Incontinence Recurrent urinary tract infections (UTIs) Chronic UTIs Dysfunctional voiding Bladder outlet obstruction (BOO) etc.

14. FEMALE HYPOSPADIAS Female hypospadias can be difficult to diagnose because of its rarity. Diagnosis is usually made by clinical examination, but other tests may include: Intravenous urogram or CT urogram – (an X-ray exam that uses a contrast dye to produce images of the kidneys, ureters, bladder, and prostate). Micturating cystourethrogram - x-ray test which is used to identify any abnormalities in a child’s urinary system and so help to identify why the child may have urinary tract infections. Surgical treatment is the primary management for female hypospadias.

15. Epispadias

16. Epispadias is a rare congenital condition in which the urethral meatus opens dorsally on top of the penis rather than the tip. In girls with epispadias , the urethral opening is located toward the clitoris or even belly area, which can prevent the outside genitalia and urethra from forming or working properly. . DEFINITION

17. Incidence: It occurs in 1 in 117,000 newborn boys and 1 in 484,000 newborn girls . Epispadias are extremely rare in female .

18. TYPES OF EPISPADIAS IN MALE 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 The epispadias is classified based on the location of the meatus on the penis.

19. 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. Some researchers have explored the possibility that exposure to certain environmental factors or toxins, smoking during pregnancy may increase the risk of epispadias .

20. Symptoms In girls Abnormal clitoris and labia narrow vaginal opening wide labia split clitoris urinary incontinence, and leaking urine

21. Symptoms In boys Widened pubic bone abnormal opening from the bladder neck to the area above the normal urethra opening, backward flow of urine into the kidney urinary incontinence, and urinary tract infections

22. Diagnostic evaluation Signs include : Backward flow of urine into the kidney 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

23. Treatment. Surgery can correct epispadias to improve the look and function of the genitals.

24. Epispadias surgery for boys Epispadias surgery for boys aims to improve : Penis function, size and look. Good urine control, if the bladder was affected. Future fertility, which is more of a concern if the bladder develops outside of the fetus ( exstrophy ) along with the epispadias .

25. Surgery types include: Modified Cantwell- Ransley technique   - rebuilds the penis. The surgeon may partially reconstruct the penis and move the urethra to a better location. Mitchell technique  completely reconstructs the penis. This ensures the urethra is in the best position and corrects chordee .

26. Epispadias surgery for girls Girls typically need less complex epispadias surgery than boys do. Usually , fertility isn’t an issue as epispadias doesn’t commonly affect the  female reproductive system . The type of surgery may depend on how early a provider diagnosed epispadias .

27. Epispadias surgery for girls If epispadias is diagnosed at birth , urinary control most likely won’t be a problem. Healthcare providers can: Connect the two parts of the clitoris. Place the urethra in the correct location . If the problem isn’t diagnosed or treated until later , girls may need surgery to: Correct incontinence (lack of urine control ). Reconstruct a narrow vaginal opening.

28. Nursing Diagnosis 1. Acute Pain May be related to Surgery Ass e ss l o cati on, c h a r acte r i s tic s, ons et , dur ati on, fr e qu e n c y , l o cati on, a nd s e v e r it y of p ai n; Obs e rve for verbal and nonverbal cues. Mai n tai n a pos iti on of c o m for t ; Prop e r l y s e t t he catheter to avoid tension Administer analgesic (e.g., Tylenol) as ordered. Educate parents that medications will prevent pain and restlessness and allow for healing.

29. Nursing Diagnosis 2. Impaired Urinary Elimination May be related to Mechanical trauma from surgery (urethroplasty) R ec ord i nput a nd ou t put ; Ass e ss vo i d i ng s t ream, c o l or a nd amount of ur i ne on f i rst f l ow of ur i ne a nd eac h su ccee d i ng void. E n c our a ge h i gh f l u i d i n ta ke a f te r cat h ete r rem ov e d, o f f e r favoured choice of liquids hourly. Support c h il d a f te r t he cat h ete r i s rem ov e d a nd prov i de privacy for voiding. Ins t ru c t p a r e n t s t o no tif y t he phys icia n of c h a ng e s i n t he urinary pattern or inability to void.

30. 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.

31. 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.