Details about the causes, symptoms, diagnosis and treatment of epispadias

One of the congenital anomalies in the formation of the external organs of the urogenital system is epispadia. This pathology is characterized by improper location of the external opening of the channel of urination (above normal).

Such a defect is found in both sexes, but men epispadia appears 5 times more often. Besides the visual defect, also there are violations of urination, sexual dysfunction and frequently occurring infectious lesions of the urinary system.

Factors of the disease

Reliably the causes of clefts of the anterior wall of the urethra is not known. It is believed that abnormalities are formed in the period from 7 to 14 weeks of fetal development of a human fetus. This forms dysphonia anterior urethral wall causes functional disorders of the urethra.

Anomalies of fetal development are also caused by viral infections (the cause of many congenital abnormalities) that a woman carries during pregnancy. During the laying of the bodies have negative impact and causes such as:

• endocrine pathology;
• bad habits;
• occupational hazards;
• early toxicosis.

There are other possible causes of epispadias.

Symptoms

The symptoms of this disorder depend on its shape. Capitate form is characterized by preserved normal function of urination (urine may splash a little). In more severe cases, other symptoms are determined by (a slight curvature of the penis), but sexual function is not impaired. If there are no visual symptoms of splitting in the area of the foreskin, this form may not be detected.

A stem version of epispadias has symptoms related to the location of the outlet of the urethra near the root of the penis. Retained voluntary control of urination, but there is a strong splashing of urine when emptying the bladder. These symptoms cause patients men usually urinate in the sitting position. When the voltage of the abdominal wall is manifested incontinence. There is a noticeable deformity of the penis (shortening or tightening to the abdominal wall), sexual intercourse is possible, though, and is somewhat complicated.

Pubic-stem form is determined on the basis of the symptoms of deformity, a shortening of the penis, which deprives the ability to have intercourse. The outer part of the urethra opens below the fold, due to a partial cleft of the urethral sphincter can result in urinary incontinence.

Total epispadia determined pronounced hook-like deformity of the penis, its underdevelopment. Erection in this formoccurs, however, this process is quite painful. Sexual intercourse impossible. This epispadia is characterized by the bifurcation of the cervical division of the bladder, the corpora cavernosa, there is external leakage of urine. Pubic diastasis causes a "duck" gait, discrepancy of muscle fibers – the "frog" belly. Some patients are determined by these symptoms:

• megaureter (big ureter size);
• hydronephrosis (accumulation of water in the capsule of the kidney);
• vesicoureteral reflux (urine reflux in the opposite direction);
• pyelonephritis;
• hypoplasia of the scrotum, testes, prostate.

Diagnostic methods

Severe epispadia is determined at birth of the patient, specific diagnosis is not required. Less visible symptoms (often girls) are detected only in the presence of urinary incontinence, it requires a careful diagnosis. Epispadia in children is determined on the basis of examination of the patient following specialists:

• pediatrician;
• surgeon;
• urologist.

In the presence of a cleft of the anterior wall of the urethra in addition to a thorough examination by a doctor (objective diagnosis) and determining the forms of this disease, conducted a comprehensive study of the state of the upper urinary tract, urethra, bladder (diagnostics).

Applied diagnostics using various techniques:

• Ultrasound diagnosis of the kidneys, bladder.
• Radiographic diagnosis: excretory urography, x-ray symphysis, cystography, urethrography.
• Urodynamic diagnosis: urethral profilometry, cystometry.
• Electrophysiological methods: electromyographic diagnosis of the muscular apparatus of the bladder.

Comorbidities are detected by the ultrasonic diagnosis of the scrotum to determine causes and to provide the most comprehensive treatment.

Treatment tactics

Capitate epispadias this pathology does not need treatment, as symptoms of low expressed and do not interfere with the patient's life. Surgical treatment is used for functional reasons (the elimination of the causes of urinary incontinence, sexual dysfunction, psychological problems), as well as to eliminate cosmetic defect. The most appropriate age for treatment by surgery is considered to be 4-6 years, some sources found in 2-4 years.

Treatment of anomalies in boys is to eliminate deformation of penis, restoring the integrity of the urethra, the sphincter of the bladder. The postoperative period is characterized by long-term rehabilitation that requires regular rinsing of the bladder and catheterization. Among the most common complications are most commonthe following symptoms:

• holes in the walls of the bladder and urethra;
• urinary incontinence;
• stricture of the urethra.

Boys possible incomplete elimination of deformation of the penis, symptoms of erectile dysfunction, infertility (the reasons for this – advanced cases of the disease). To prevent these complications is important for timely diagnosis and adequate treatment.

Forecast

The sooner it is performed the surgical treatment of a person diagnosed with epispadia", the more adapted it will be in society. Fertility and sexual functionality of the patient is determined by the presence of concomitant pathological developmental disorders of the genitourinary system, their timely treatment.

It is important to eliminate possible causes of the pathology to prevent recurrence. Special attention should be paid to even minor symptoms, and it is better to consult a doctor.

These videos are not intended for entertainment.