What Is an Epispadias?

Upper urethral fissure is a congenital malformation of the outer urethra caused by a fusion defect in the dorsal side of the urethra. In male patients, the outer urethral orifice is located on the dorsal side of the penis. In female patients, the upper urethral fistula, clitoris division, and labia majora Wider. Because congenital urethral lobes are often concurrent with bladder eversion, embryology can be considered as part of bladder eversion. Upper urethral fissure is more common in men, with a male to female ratio of about 3: 1.

Basic Information

English name

epispadia

Visiting department

surgical

Multiple groups

male

Common causes

Abnormalities in the process of migration from genital nodule primordium to cloaca

Common symptoms

Abnormal position of urethral opening, urinary incontinence, external genital malformation, urinary system infection, sexual dysfunction, etc.

Causes of upper urethral fissure

The upper urethral fissure occurs early in the embryo and is caused by abnormalities in the process of genital nodule primordium migration to the cloaca. The specific cause is not clear. It is often associated with eversion of the bladder. Light one.

Clinical manifestations of urethral fissure

Clinical manifestation

(1) Abnormal position of urethral opening Male urethral opening can be located from the pubic symphysis to the top of the penis. Female abnormal urethral openings are located between the clitoris and labia, and the distal urethra is absent.

(2) Urinary incontinence The severity of urinary incontinence in men is mainly determined by the degree of dorsal ectopic urethral defect. 90% of female patients have urinary incontinence. Causes of urinary incontinence include: loss of urethral sphincter; dysplasia of the bladder, small volume; decreased urethral resistance.

(3) Malformation of the external genitalia Male patients have poor penile development, flat penis head, short and wide penile body, split dorsal foreskin, and often accompanied by penile shortening and dorsal warpage. Females are flattened and lowered due to the pubic symphysis, and the anterior and posterior labia are separated. The labia are poorly developed, and the clitoris and foreskin are split.

(4) Separate pubic symphysis Only the fibrous tissue is connected between the left and right pubic bones, and the distance between the sciatic nodules is widened.

(5) Reflux nephropathy Some patients may be accompanied by accompanying malformations and bladder ureteral reflux.

(6) Urinary tract infection Most patients can be complicated by urinary tract infection.

(7) Sexual dysfunction Most of the male patients can not have sexual intercourse because the penis head is bent to the abdominal wall. Some ejaculation function is good, some because the bladder neck can not be closed, semen flows back into the bladder.

2. Clinical typing

(1) The male urethral orifice is divided into the following three types: Penile head type The urethral orifice is opened on the dorsal side of the wide and flat penis, and urinary incontinence rarely occurs; Penis type The urethral orifice is opened on the pubic symphysis Between the coronary sulcus, the urethral opening is broad and cough-shaped, and the distal end of the urethral opening is sulcus-like to the head of the penis; Often associated with eversion of the bladder.

(2) Women are divided into three types: light, medium and heavy. light type, also known as clitoral type, wide urethral opening; medium type, also known as the pubic symphysis type, most of the dorsal urethral dehiscence; heavy type, also known as complete type, dorsal urethral dehiscence with urinary incontinence.

Upper urethral examination

Diagnosis is based on typical clinical manifestations. B-ultrasound can screen the kidney and ureter for malformations. Urography helps to understand the condition of the upper urinary tract. Renal nuclide scanning can comprehensively check renal function and renal blood flow. Urodynamics can understand lower urinary tract function.

Treatment of upper urethra

The surgical treatment of the urethral fissure is to reconstruct the urethra; control and treat urinary incontinence; and correct external genital deformities. All types of male urethral fissure require surgery, mainly to correct penile deformities, reconstruct sexual function and satisfactory shape of the penis, repair urethral deformities, reconstruct urethra and treat urinary incontinence, control urination, and protect renal function. Female urethral fissure often does not require surgery due to incontinence. The purpose of surgery is to extend the posterior urethra and reconstruct the bladder neck to control urination and correct female external genital deformities.

Male patients are recommended to be operated after 3 years of age. It is advisable to be 4 to 5 years old in order to have a well-developed bladder with appropriate volume and muscle. Boyhood development during puberty is conducive to urine control. Surgery for female patients can be performed between 18 months and 2 years of age. External genital urethral bladder neck reconstruction can be completed in one stage or in stages. External genital urethroplasty is performed first, and bladder neck shaping is performed at 4-5 years old. The volume can reach more than 50ml. Children can also receive urinary training.

Prevention of epispadias

There is currently no clear prevention method or drug for upper urethral fissure. Therefore, pregnant women should carry out scientific perinatal health care and regular prenatal examination during the perinatal period, which is helpful for the early diagnosis and treatment of the disease.