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Epispadias Repair
(Female)
What is
Epispadias Repair (Female)?
Epispadias (also called bladder exstrophy) is a
rare congenital defect in females in which there
is a fissure in the upper wall of the urethra.
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Effects
of Epispadias Repair (Female)
Females with simple
hypospadias also have normal lives, including
conceiving and bearing children.
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Candidates for Epispadias Repair (Female)
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.
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Your Consultation
A
child who is suspected to have epispadias is
recommended to undergo tests such as the
following:
. CBC
. Serum electrolytes
. Pelvic x-ray
. Intravenous pyelogram (IVP)
. Ultrasound of the urogenital system
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The
Epispadias Repair (Female) Procedure
Genital reconstruction in girls with bladder
exstrophy is less complex compared to the
reconstruction in boys. The urethra and vagina
may be short and near the front of the body and
the clitoris is in two parts. The internal
female structures - uterus, fallopian tubes and
ovaries - are normal. If diagnosed at birth, the
two parts of the clitoris can be brought
together and the urethra can be placed into the
normal position. If repaired early enough, lack
of urinary control (incontinence) may not be a
problem. If the diagnosis is missed or if early
repair is not performed, then incontinence can
be surgically corrected at the time of
diagnosis. If the vaginal opening is narrow in
older girls or younger women, reconstruction can
be performed after puberty.
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Recovery
Surgical repairs generally produce both
continence (the ability to control the flow of
urine) and a good cosmetic outcome.
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Risks
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.
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Frequently Asked Questions
Q:
How does epispadias affect girls?
A:
Epispadias is much more rare in girls, with only
one of 565,000 affected. Those who are affected
have pubic bones that are widely separated to
varying degrees. This causes the
clitoris not to fuse during development,
resulting in two halves of the clitoris.
Furthermore, the
bladder neck is almost always affected. As a
consequence, girls with epispadias invariably
leak urine with stress (e.g., coughing and
strenuous effort). Fortunately, in most cases,
early surgical treatment can resolve these
problems.
Q:
How is epispadias diagnosed?
A:
The diagnosis of epispadias is typically made at
birth. Although, on occasion when the
malformation may not be drastic, epispadias has
been missed at birth and only becomes apparent
when the child (usually female) remains wet
after toilet training.
Q:
What are the symptoms of epispadias?
A:
The symptoms and signs in females are:
-
Abnormal opening from the bladder neck to the
area above the normal urethal opening
-
Bladder exstrophy (may or may not be present)
-
Widened pubic bone
-
Bifid clitoris, rudimentary labia
-
Urinary incontinence
-
Reflux nephropathy
-
Urinary tract infections
Q:
How is the treatment approached?
A:
Genital repair is often accomplished at
different times for the boy and girl with
exstrophy. In females, the genitalia and
urethral repair can often be accomplished at the
time of the initial bladder closure. In males,
reconstruction of the penis and urethra (epispadias
repair) is usually accomplished between 1 and 2
years of age. This surgery is also important in
that it usually causes some urethral resistance,
which in turn results in pooling of urine in the
bladder which can stimulate bladder growth and
capacity.
Q: Can epispadias be prevented?
A:
There is no known prevention.
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The following list of Urology procedures are
performed at Beverly Hills Medical Group -
please click the links to find out more:
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