Presentation of hypospadias and epispadias

Presentation on hypospadias and epispadias
For medical student seminar

1. SEMINAR ON HYPOSPADIAS AND EPISPADIAS BY ASHWINI.M BSC NURING 3RD YEAR BCON

2. INTRODUCTION 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. The urethra is the tube through which urine drains from your bladder and exits your body.

3. DEFINITION Hypospadias Is Congenital Defect Primarly Of Male In Which The Urethra Open On The Underside ( Ventrum ) Of The Penis It Is One Of The Most Common Congenital Abnormalities. In Male The Incidence Of Hypospadias Is Approximately One Per 250-300 Live Birth

4. INCIDENCE Hypospadias occurs in up to 4 in 1,000 newborn boys . The reason why the penis does not develop properly is still not clear . The development of the penis whilst the baby is growing in the womb is partly dependent on the male sex hormones such as testosterone . The effects of testosterone on the growing penis may be blocked in some way . Although it is not a genetic condition, hypospadias can run in some families

5. TYPES Glandular hypospadias: Most common variety . * Coronal hypospadias: Meatus is placed at junction of underside of glans and body of penis . * Penile and penoscrotal hypospadias: Opening is on underside of penile shaft . * Perineal hypospadias: Scrotum is split and urethra opens between its two halves.

6. RISK FACTOR Age and weight: Mothers who were age35 years or older and who wereconsidered obese had a higher risk of having a baby with hypospadias . Fertility treatments: Women who usedassisted reproductivetechnology to help with pregnancy had a higher risk of having a baby with hypospadias . Certain hormones: Women who took certainhormones just before or during pregnancy wereshown to have a higher risk of having baby with hypospadias . Exposure to smoking and chemicals: There is somespeculation about an association between a mother's exposure to pesticides and hypospadias . Family history: This condition is more common in infants with a family history of hypospadias.

7. CAUSES Unknown In vitro fertilization Advance maternal age Genetic factor Several teratogenic drugs Lack of hormonal production during fetal life

8. CLINICAL MANIFESTATION Pain Difficulty In Urinating Apening Of Wattira Near The Tip Of Penis On The Underside Downward Cows Of The Penis Hooded Appeccance Of The Penis Only The Top Half Of Ho Penis Is Coverd By Foreskiy Abnormal Soraying Of Urine Diving Urination Voiding In Sitting Position In Boys

9. DIAGNOSTIC EVALUATION HISTORY COLLECTION PHYSICAL EXAMINATION IMAGING TEST TO LOOK FOR OTHER CONGENITAL DEFECT

10. MEDICAL MANAGEMENT 1. Medical management Minor cases of hypospadias, in which the meatus is located up toward the tip of the glans, may not require surgical repair and may simply be managed with observation . 2 . Adjuvant hormonal therapyPresurgical treatment with testosterone injections or creams, as well as HCG injections, to promote penile groWTH and for the improvement in chordee with lessening in the severity of the hypospadias.

11. SURGICAL MANAGEMENT Urethroplasty

12. MEATOPLSTY

13. COMPLICATION BLEEDING IMPAIRED HEALING WOUND INFECTION BREAKDOWN TO REPAIR

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

15. DENINITION Epispadias Is A Congenital Defect Of Male In Urethra Opens On The UPPER Surface (Dorsum) Of Penis . The Corresponding Defect In Females Is A Fissure In The Upper Wall Urethra Which Is Very Revere Epispadias Is Less Than Common Than On Hypospadias Which An Incidence Are Per 100,000 LIVE IN Male Birth

16. TYPES mild Epispadias moderate Epispadias Severo Epispadias

17. RISK FACTOR Factors that might increase the risk of undescended testicle in a newborn include : Low birth weight Premature birthFamily history of undescended testicle or other problems of genital development Conditions of the fetus that can restrict growth, such as Down syndrome or an abdominal wall defect Alcohol use by the mother during pregnancy

18. CLINICAL MANIFESTATION Absent anterior bladder wall and exposed bright red posterior. Constant urine odor and skin excoriation . Ulcer of bladder mucosa. Infection External rotation of the pelvis . Females frequently have a displaced and narrowed vaginal orifice, a bifid clitoris, and divergent labia.

19. DIAGNOSTIC EVALUATION History COLLECTION Physical Examination Ultrasound Of Couracy Sistem Andgenitailatup MRI And CT Scan Moine Culture And Sensitivity

20. TREATMENT Modern Staged Repair Of Exstrophy (MSRE): The Initial Step Is Closure Of The Abdominal Wall, Performing Pelvic Osteotomy At Approximately 6 Months Of Age. The Patient Then Undergoes Repair Of The Epispadias After Testosterone Stimulation. Finally, Bladder Neck Repair Usually Occurs Around The Age Of 4-5 Years. Complete Primary Repair Of Exstrophy ( Cpre ): The Bladder Closure Is Combined With An Epispadias Repair, In An Effort To Minimize Costs And Morbidity.

21. NURSING MANAGEMENT Teach the parents to keep the bladder area clean, cover it with sterile petrolatum gauze to prevent infection and ulceration of mucosa. Apply a bland ointment around the bladder area to protect against draining urine.* Change the diaper frequently . Clean the stool immediately to prevent contamination . Avoid straining of stool to prevent rectal prolapse . Provide loose clothing to avoid pressure on the bladder wall . Avoid immersing the infant during bath to prevent contamination of bladder wall . Collect urine sample from the opening of the bladder with a medicine dropper or a syringe . Provide routine postoperative care.Keep the abdominal dressing clean and dry . Prevent kinking of any drainage tubing Teach the parents to identify signs of infection or other complications.* Reassure the parents with adequate information . Involve the parents in child care.

22. COMPLICATION Urinary incontinence . Urinary tract infections . Widened pubic bone.

23. CONCLUSION Hypospadias and Epispadias are Congenital woettoral anomalies affecting males an sharing Similaritis

24. JOURNAL Hypospadias and epispadias Vitrag P Blair, Louis T Byars The Journal of Urology 40 (6), 814-825, 1998 In the operative correction of hypospadias and epispadias during childheed , the urethra is of primary interest, but in adult life a restoration that has failed to relieve the ventral flexion of the penis is net apt to be acceptable. A correction of an epispadias that disregards the retraction of the penis or the incontinence will be equally unsatisfactory, while to allow a child to reach self-consciousness or beyond with the attending physical and mental discomforts essential to these deformities, and the added fear of impending operations is kind neither to the patient nor to the parents.

25. BIBLIOGRAPHY Panchali pal " Testbook of pediatricnursing 2nd edition page no: 340 to 342 . Parul Doffa pediatrir nwering 5th edition Jaypa PUBLICATION 2007

26. Thank you