Understanding Epispadias and Surgical Intervention

The condition results in a urinary opening that does not work well or form in common locations. For males the urethra opens on top of or on the side of the penis, often near the base. For females the urethra forms near the clitoris or even higher, near the stomach. Surgery is required to fix this defect in males and females, with the goal of restoring function and appearance. Epispadias is a rare congenital condition that can affect males and females, though is more common with males.

Understanding the Condition

While it is unknown how this defect is caused, it is characterized by improperly formed pelvic bones. The urethra doesn’t fully form which results in the urinary opening in the wrong place. This condition is often diagnosed at birth. In less extreme cases the condition won’t be detected until later, normally during potty training when the child experiences urine leaks or frequent urinary tract infections. Females will have abnormal clitoris and labia.

Generally, males who suffer this condition will also experience a wider and shorter penis that curves upward. The urethra forms on top or on the side of the penis instead of at the tip and is wider than average. Besides potential cosmetic issues, this condition affects the bladder’s ability to hold urine and boys or girls with this condition will leak urine. The curvature of the penis in males can also cause discomfort as well as hindering sexual relations later in life.

Treatment Options

Surgery is the only solution to return bladder continence and achieve a normal appearance. Surgery closes the bladder wall and often also adjusts the pelvic bones. The goal during surgery is also to straighten and elongate the penis to restore a normal appearance. During surgery the surgeon will also move the urinary opening to the correct location. There is more than one method for surgery including rebuilding the penis, or less often completely taking it apart and reassembling it for ideal function and appearance.

Surgery for females is less complicated. For females surgery places the urethra in the correct location and the two parts of the clitoris will be put back together. Early surgery in females can often completely circumvent incontinence problems before they begin.

Prognosis

While surgery can help to restore the look and function of the urethra and penis, problems with incontinence and infertility may persist. The goal of surgery is to restore regular function and appearance but is not always completely successful. Your doctor can further evaluate your child’s specific needs and what kind of surgery to pursue.

Final Thoughts

While this congenital condition is often apparent at birth, parents who suspect their children are suffering can consult a pediatric urologist for further testing to determine the problem. Oftentimes this condition is associated with other deformities, but sometimes presents on its own. Surgery is necessary to correct function and appearance and to help achieve normal quality of life.