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Epispadias Repair (MALE)
- What is Epispadias Repair (MALE)
- Effects of Epispadias Repair (MALE)
- Candidates for Epispadias Repair (MALE)
- Your Consultation
- The Epispadias Repair (MALE) Procedure
What is Epispadias Repair (Male)?
Most boys are born with fully functioning genitalia. But a congenital condition called epispadias can produce a penis that not only performs inefficiently, but also looks abnormal. Luckily, pediatric urologists have various surgical techniques at their disposal to repair the ill-placed urethral opening, hooded foreskin and curvature associated with this condition.
Effects of Epispadias Repair (Male)
With adequate surgical repair, most males with simple hypospadias can lead normal lives with a penis that appears and functions in a normal manner. This includes fathering children.
Candidates for Epispadias Repair (Male)
Several leading reconstructive surgeons have championed early repair of epispadias, especially in boys with penopubic or penile epispadias and all girls with the condition. If surgery is performed within the first few months of life, the child may have a better chance of having a normal bladder. Today, most patients undergo epispadias reconstruction at 12 months or even earlier.
A child who is suspected to have epispadias is recommended to undergo tests such as the following:
- Serum electrolytes
- Pelvic x-ray
- Intravenous pyelogram (IVP)
- Ultrasound of the urogenital system
The Epispadias Repair (Male) Procedure
There are two popular surgical techniques that achieve these objectives. The first is the modified Cantwell technique, which involves partial disassembly of the penis and placement of the urethra in a more normal position. The second technique and most recent evolution of the modern epispadias repair is the Mitchell technique. It involves complete disassembly of the penis into its three separate components - two corpora cavernosa and a single corpus spongiosum. Following disassembly, the three components are reassembled such that the urethra is in the most functional and normal position and dorsal chordee is corrected. Both techniques provide a straight urethra positioned on the underside of the penis, correction of chordee and an acceptable cosmetic result. The Mitchell technique has a lower complication rate and facilitates bladder and bladder neck repair. Sometimes, boys with the exstrophy-epispadias complex are born with a very small or severely underdeveloped penis. In these situations, surgical reconstruction of the penis is more difficult.
Surgical repairs generally produce both continence (the ability to control the flow of urine) and a good cosmetic outcome.
Persistent urinary incontinence can occur in some people even after multiple operations. Also upper urinary tract (ureter and kidney) damage as well as infertility may occur.
What is epispadias?
Epispadias (also called bladder exstrophy) is a congenital defect of males in which the urethra opens on the upper surface (dorsum) of the penis.
What are the symptoms of epispadias?
- Abnormal opening from the pubic symphysis to the area above the tip of the penis
- Bladder exstrophy (may or may not be present)
- Widened pubic bone
- Short, widened penis with chordee (abnormal curvature of the penis)
- Urinary incontinence
- Reflux nephropathy
- Urinary tract infections
How does epispadias affect boys?
In affected boys, the penis is typically broad, shortened and curved toward the abdomen (dorsal chordee). The penis may be attached to the pelvic bones, which are widely separated, resulting in a penis that is pulled back toward the body.
When is the best time to get treatment?
Several leading reconstructive surgeons have championed early repair of epispadias, especially in boys with penopubic or penile. They have demonstrated that there is reasonable increase in the bladder capacity after epispadias reconstruction. A well-developed bladder is a prerequisite for satisfactory urinary control, and early bladder filling and emptying (cycling) may promote bladder growth and storage function. Therefore, if surgery is performed within the first few months of life, the child may have a better chance of having a normal bladder. Today, most patients undergo epispadias reconstruction at 12 months or even earlier.
What can be expected after treatment?
An abnormal hole in the urethral tube used to be quite common after a major epispadias repair. With today's technical improvements, this is fairly uncommon with a rate of formation as low as 6 percent. Persistent dorsal chordee is fairly typical with older reconstructive techniques for epispadias. It is now less common with newer treatment techniques. Epispadias repair does little harm to erectile function.