A new baby is a great joy to have in the family. At the same time, a mother or father feels a great responsibility and sometimes a little fear about even the smallest things. We all care about whether everything is fine with the baby and whether he is healthy. So, sometimes the doctor examines the baby and tells him about a small change that he was born with, and it is normal to feel a great burden on the heart. Today we are going to talk about such a very rare, but completely curable condition with treatment. That is Epispadias.
Simply put, what is Epispadias?
Epispadias is a rare birth defect. It affects the tube that carries urine out of the body. We call it the urethra. Simply put, this is the tube that carries urine from our bladder out of the body. In a baby with epispadias, this urethra is not fully developed.
Although this condition is more common in boys, it can also occur in girls very rarely. But don't worry, this can be completely corrected through surgery by pediatric urologists, who specialize in diseases related to the urinary system in children.
Epispadias is often seen together with another birth defect called Bladder Exstrophy. This is an even rarer condition where the baby's bladder is located outside the abdomen instead of inside it.
How does Epispadias affect a male child?
If a boy has this condition, his genitals may look slightly different. Common symptoms include:
- Short and wide penis: The penis may become slightly short and wide, and may be bent upwards (dorsal chordee).
- Urethral stricture: Normally, the urethral meatus is located at the tip of the penis. However, in these children, the meatus is located somewhere on the top of the penis. Sometimes, there may be a long groove from the meatus to the tip of the penis.
Types of Epispadias in Boys
Doctors classify this condition into several types based on the exact location of the urethral meatus. This is because how close the meatus is to the base of the penis can affect the bladder's ability to hold urine. Let's take a closer look at the table below.
| Type of Epispadias | Simple explanation |
|---|---|
| Glanular epispadias | This is the most common type. Here, the urethral opening is located above the glans penis (the head of the penis). |
| Penile epispadias | Here, the urethral opening is located somewhere along the shaft of the penis. |
| Penopubic epispadias | This is a slightly more complicated condition. The urethral opening is located near the pubic bone. Because the two pelvic bones in these children are not fused together properly, the sphincter muscle that controls urination cannot close completely. |
How does Epispadias affect a girl?
This condition is very rare in girls, but if it does occur, these are the symptoms you'll see:
- The urethral opening may be on the side of the clitoris or sometimes on the lower abdomen.
- Because the pubic bones are far apart, the vagina may be separated into two parts and not joined in the middle.
- The labia may appear underdeveloped.
- Problems with the bladder neck can occur, which can lead to difficulty controlling urine.
What is the difference between Epispadias and Hypospadias?
These two names may sound a bit similar. Both are birth defects that occur in the urinary tract. The difference is where the urethral opening is located. Epi means "above. " Hypo means "below."
| Characteristic | Epispadias | Hypospadias |
|---|---|---|
| Location of the urethral opening | Somewhere on the top of the penis. | Somewhere on the underside of the penis. |
| Who is affected? | It is more common in boys, but can also occur in girls. | It mainly affects male children. |
What is the reason for this situation?
Researchers have not yet found a specific cause for this, but they believe that the condition is caused by a problem that occurs during the early stages of development of the baby's body parts in the womb, specifically in the cloacal membrane, where the urinary, digestive, and reproductive systems are formed.
The important thing is, this is not the fault of the mother or father. Don't feel bad about it because of something you did or didn't do during pregnancy.
How to diagnose the disease?
This condition is usually diagnosed during the first check-ups the doctor does after the baby is born in the hospital. Doctors can easily recognize it because of the abnormal appearance of the penis in a boy or the scrotum and labia in a girl.
However, sometimes this condition is very mild and may not be detected in the hospital. In that case, parents may only notice a little urine leakage during toilet training. Girls are more likely to be diagnosed with this condition later.
If your doctor suspects this condition, he or she will refer you to a pediatric urologist.
How is it treated? Is surgery necessary?
Yes, surgery is required to correct Epispadias. The main goals of this surgery are to restore the appearance and function of the genitals.
Doctors recommend that this surgery be performed as early as possible, meaning when the baby is still young, because that is when the best results can be achieved in terms of things like bladder control. Sometimes, the child may need to have more than one surgery.
Objectives of surgery
- For boys: Restores the function, size, and appearance of the penis, provides urinary control, and preserves future fertility.
- For girls: The surgery for girls is relatively simple. It mainly involves joining the two parts of the vagina together and placing the urethra in the correct position.
There are different surgical techniques, such as the ``Modified Cantwell-Ransley technique'' and the ``Mitchell technique''. Your doctor will discuss with you which method is best for your child.
Common questions you have as a parent
It's normal for a lot of questions to arise in your mind at a time like this. Let's try to answer them.
How long does it take to recover after surgery?
This depends on the complexity of the surgery. If it is a minor surgery, the child will recover quickly. However, if the surgery was performed for a condition like `(Bladder Exstrophy)`, it may be one of a series of surgeries, so it will take a while to recover.
Can surgery cause complications?
In the past, there was a risk of a fistula opening from the urethra to the skin after surgery. But with today's advanced surgical techniques, this is rare. Even then, the hole can close on its own or be closed with another minor surgery.
In what situations do you need to see a doctor immediately?
After surgery, seek medical advice immediately if your child has these symptoms:
- High fever
- If the surgical site is swollen, red, or oozing pus (signs of infection)
- Any other symptoms that are bothering you
Does this condition affect sexual function?
No. Properly performed Epispadias surgery does not affect erectile function.
Is there an effect on fertility?
Female fertility is usually not affected. However, males with complex conditions such as penopubic epispadias or exstrophy-epispadias complex may have problems conceiving. However, surgery can help reduce these problems. It is important to discuss this with your doctor.
Can my son be circumcised?
Your doctor may advise you to postpone circumcision until after surgery. This is because the surgeon may need foreskin tissue to rebuild the penis during surgery. After epispadias surgery, you can talk to your doctor about circumcision if you want to.
Take-Home Message
- Epispadias is a rare congenital condition that is not caused by any fault of the parents.
- This condition is diagnosed by doctors in the hospital as soon as the baby is born. So there is no need to worry.
- Surgery can completely correct this condition, restoring the appearance and function of the genitals to normal.
- By having surgery as soon as possible, very good results can be achieved in things like urinary control.
- Your doctor will give you clear instructions on how to care for your child after surgery and when to see the doctor again. It is very important to follow those instructions.
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