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Epispadias Repair
(MALE)
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.
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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.
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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.
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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 (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.
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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:
What is epispadias?
A:
Epispadias (also called bladder exstrophy) is a
congenital defect of males in which the urethra
opens on the upper surface (dorsum) of the
penis.
Q:
What are the symptoms of epispadias?
A:
In males:
-
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
Q:
How does epispadias affect boys?
A:
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.
Q:
When is the best time to get treatment?
A:
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.
Q:
What can be expected after treatment?
A:
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.
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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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