Epispadia - Causes, symptoms and treatment. MF.
Jun 04, 2018
Epispadia is a congenital anomaly of the development of the external genital organs, when the external opening of the urethra opens above its normal location, for example in boys - on the upper surface of the penis or on the pubic area.
Much more rare epispadia occurs in girls, and is manifested in one girl at 565,000 compared with 1 case per 100,000 boys.
Causes of epispadias
Epispadia is a type of anomaly in the development of the genitourinary system in newborns. To date, active work is not only to study the treatment and diagnosis of this disease, but also to clarify the immediate cause of the anomaly. It should be noted that in spite of the high level of medicine, the exact causes of epispadias can not be named in any foreign urological clinic.
Along with this, there are a number of factors that can in some way increase the risk of childbirth with such an anomaly. First of all, such factors include ionizing radiation, under the influence of which are people living near nuclear power plants and other strategic facilities on which radioactive metals are stored.
If there are not so many radioactive contamination zones in the country, there are much more smoking mums. And according to some information, smoking and drinking alcoholic beverages during pregnancy have an equally negative effect on the fetus, rather than the toxic dose of ionizing radiation.
The impact of chronic stress and traumatism on fetal development has not yet been fully proven, but some scientists actively adhere to this thought and continue to promote it among pregnant women.
Symptoms of epispadias
Unlike a similar disease, hypospadias, this abnormality of the urethra can not develop in a latent form. Anyway, but if the opening of the urethra is located on the upper surface of the body of the boy's penis, then it is simply impossible not to notice the anomaly, even during the period of the newborn. Attention is drawn, first of all, to the nature of the urine stream, which is not directed downward, as in healthy children, but upwards. When the opening of the urethra on the pubis is located, the penis practically does not take part in the act of urination. In this case, urine is released, in fact, on the tummy of a child and, draining down, irritates the skin of the genital organs and perineum.
In case of inattentive examination, if an incorrect location of the urethra is not detected, skin irritation can be confused with ordinary diaper rash, which is also manifested by reddening of the skin of the external genitalia and perineum. Parents begin to use children's powder, which in this situation are ineffective. In the absence of normal treatment, inflammation can go to the purulent stage, which ends with skin rejection and the formation of deep ulcers.
As a rule, the disease debuts from the very birth of the child. At the same time, the kid becomes restless, fussy, poorly gaining weight, refuses breast and often wakes up at night.
Epispadia in girls is partial and complete. With partial epispadias, the clitoris is split or absent, a discrepancy of the labia majora is seen in the pubis( there is no anterior adhesion of the labia), the labia minora are underdeveloped, the external opening of the urethra is localized under the lone articulation. When urinary incontinence, the external opening gap and urine flows out of it. In the case of full epispadias, the labia majora widely diverges at the pubis and the genital cleft is not occluded, signs of underdevelopment of the anterior abdominal wall and a divergence of the pubic bones are noted. The clitoris is absent. The entrance to the bladder, located in the region of the pubic articulation, gaping, easily stretches and freely passes the finger. Urine continuously flows outward, causing changes in the adjacent skin.
If the child has a similar general symptomatology, which is accompanied by skin irritation in the area of the vulva, then it should be shown to the urologist. A qualified specialist can correctly diagnose and determine the optimal treatment tactics so that in the future the boy does not suffer from erectile dysfunction and infertility.
Diagnosis of epispadias
As a rule, one clinical picture is already enough to diagnose epispadias. If you observe the baby during urination, you can see that the urine is not released from the normal urethra, but from a pathological hole located on the upper surface of the body of the penis or, at all, on the pubis.
However, for the purpose of differential diagnosis and for the correct conduct of an operation, the diagnosis must be confirmed by additional methods of investigation. The most common and, accordingly, the most accurate method of verifying epispadias is contrast urethrography. To perform it, a contrast agent is injected into the bladder cavity through the urethral catheter, and during the act of urination, an examination of the penis and pelvic organs in the lateral projection is performed. The picture clearly shows both the bladder itself and the shape of the urethra. Most often, it simply opens in the wrong place, but there are also cases when the urethra has additional strokes that blindly end in the thickness of the penis. It is for their detection and it is necessary to conduct X-ray diagnostics.
Treatment of epispadias
Correction of this developmental anomaly is possible only by an operative method. The size of the operation depends on the shape of the epispadias. If the opening of the urethra in the boy opens on the body of the penis, not far from the urethra, then in such a situation it is possible to hold the urethra plastic by its own tissues. After excision of the pathological hole, the urethra stump is moved to the desired place, followed by its ligation.
With a short urethral stump or severe epispadias, when the urethra is located above the pubic bone, it is necessary to perform a plastic surgery with synthetic implants.
It should be remembered that if at the time of the surgery the patient has irritation and reddening of the skin of the external genitalia, the operation must be postponed. First of all, in such a situation, it is necessary to cure local inflammation of the skin. To do this, antiseptic solutions such as chlorhexidine are used, which are applied to the affected area after each act of urination.
Operative treatment of epispadias
With absolute contraindications to surgery, which are caused by severe diseases of internal organs or failure of parents to treat, conservative tactics are applied to patients. It is aimed primarily at preventing purulent inflammation of the skin around the opening of the urethra. This is achieved by the toilet of the external genitals after each act of urination and treatment of the affected area with antiseptic solutions.
In girls and women, only urinary incontinence is the indication for epispadia surgery, therefore the main goal of plastic surgery is to create a closing device.
disease In the operative treatment of pathology, rehabilitation is aimed at preventing secondary infection of the wound and ruptures of the formed anastomosis. To prevent infection, conventional antibiotic therapy is used. Since no cavity of the human body is opened during such an operation, one antibacterial preparation, as a rule, is sufficient for effective extermination of pathogenic pathogens.
Prevention of anastomosis failure is performed by placing a conventional urethral catheter. He not only removes urine from the bladder, but also acts as a framework, thanks to which a new urethra is correctly formed.
Features of nutrition and lifestyle
The correction of the diet is to limit the consumption of large amounts of liquid, which increases the level of daily diuresis, which also has a negative effect on the functional state of the urethral anastomosis.
Among the correction of lifestyle can be distinguished, perhaps, only wearing a urethral catheter. But, given the fact that surgery with such a pathology, as a rule, is carried out during the period of newborn, this does not particularly affect the patient's state of health. In turn, parents should be taught to change the urethral catheter and inject antiseptic solutions into the bladder cavity. This is done to prevent pressure ulcers of the urethra, as well as to prevent secondary cystitis.
Treatment with folk remedies
Since the only way to correct this developmental anomaly is surgery, folk methods of treatment lose their relevance. A variety of broths of chamomile and other herbs, which are often recommended by folk healers, have only a local anti-inflammatory effect. This removes skin irritation for a while, but does not eliminate the primary cause of the disease.
Complications of epispadias
It has been said more than once that the most common complication of epispadias is maceration and inflammation of the skin around the opening of the urethra. Normally, it opens on the mucous membrane of the glans penis, when it hits, urine does not have any negative effect. The skin does not have such barrier capabilities, so the constant exposure to it of urine leads to rapid destruction of the epidermis and inflammation of its deeper layers. With poor hygiene, a bacterial infection quickly joins this clinical condition, which ends with a purulent inflammation. The lack of treatment at this stage may threaten general septic events and even death.
The next group of complications of epispadias can be considered mental disorders. They develop if the correction of pathology has not been made in the period of newborn. With age, children begin to notice their inferiority, which often develops into psychological complexes associated with sexual life. Even after the operation at an older age, there is a fairly persistent psychological block that does not allow a man to get acquainted with a woman and start a family.
Prevention of epispadias
It is extremely difficult to prevent any congenital anomalies of development, as their cause is still not known. Only then can we say for sure that the refusal to drink alcohol and smoking during pregnancy lowers the risk of developing a child with epispadias several times. The same applies to the stay of a pregnant woman in a zone with a high level of radiation.
In order to exclude the possibility of septic complications and prevent psychological disorders in a child, epispadia should be diagnosed at an early stage. In principle, this should be done by a neonatologist in the maternity ward. But often there are situations when pathology is missed by specialists. Therefore, it is also necessary to watch out for the parents. As already mentioned, if a child has a worsening general condition and has skin irritation in the panty zone, he is a potential client of a pediatric urologist.
Rev.the doctor the urologist, the sexologist-andrologist Plotnikov А.N.