Epispadias: Causes, Symptoms, Treatment, Types

Epispadias is a birth defect, a deformation of the urethra which is the opening, through which urine passes out of the body. In epispadias, the urethra has a deformed opening in the end that affects the way urine is passed out of the body. It is a rare defect but can be troublesome if not treated appropriately. In females, epispadias is very rare but can be serious if it occurs. It is estimated that epispadias occurs up to one in one lakh in males and one in five lakhs in females.

While the exact cause of epispadias is not clearly understood, it is believed to be influenced by a variety of factors. Being a birth defect, it is believed that the cause of epispadias may be related to the embryonic development of the fetus during the first few months of pregnancy. The deformation is likely possible during the fifth week of gestation and be associated with improper development of the pubic bone. However, more research is needed regarding the causes of epispadias.

To understand the types and treatment of epispadias, it is essential to know the symptoms of epispadias. The main symptom of epispadias is the shape of the urethra which gets abnormal and becomes much shorter and wide. In epispadias, the opening of the urethra is either on the top of the urethra or on the sides of it.

In case of females, the symptoms are different as the labia and the clitoris becomes abnormal in shape and it is between these two that the urethra opens. In some cases, the urethra can open in the belly as well. This becomes more problematic because the person has trouble in controlling the urination.

Based upon the urethra or meatus opening, types of the epispadias in males include

• Penile Epispadias – The opening of urethra is on the shaft of the penis.
• Penopubic epispadias – In this type of epispadias, the location of urethra is near the pubic bone. As the pubic bones do not merge properly in the front, the bladder does not have any specific closure. Instead of any kind of closure, bladder becomes horseshoe shaped, which causes leakage of urine. Stress or increased abdominal pressure can lead to leakage of urine or stress incontinence of urine.
• Glandular Epispadias – In this type of epispadias, the opening of urethra is found at the head of penis, which makes it appear normal. Men in this case can hold the urine and can manage. This type of deformity can be treated medically and surgically, if appropriate.

The treatment of epispadias largely depends on its type. The location of urethra or meatus in epispadias helps in deciding the severity of the disease. When the location of meatus is close to the penis, it can cause trouble in holding urine for a long time. Some cases of epispadias, which affect moderately may need to be treated surgically.

Also, as the condition is closely related to the genitals, which are the most sensitive part of the body, surgical treatment needs to be planned carefully.

The treatment of epispadias for boys includes the following considerations:

• The purpose of the treatment is to make the penis look normal and make it have a good length
• The bends on the penis should be fixed so that it can have a normal functioning

The aim of the surgery is that the fertility of the child needs to be secured so that it is easier for the child to lead a normal life even after the surgery. There are different types of the surgeries for the epispadias treatments that are as follows:

• Modified Cantwell Technique – In this, the penis is subjected to rebuilding so that urethra is moved to a more normal position.
• Mitchell Technique – In this treatment of epispadias, the penis is pulled out completely from its place and then it is joined back together after correction. The aim of this procedure is to maintain optimal functioning of urethra.

In case of girls the treatment of epispadias is simpler. It is best treated when detected at the time of birth, as the surgery at tender age is carried out much easily as compared to the growing years. Therefore, it is best to get the child diagnosed so that she can lead a normal life later on. It is important that any changes in the urethra noted after birth of the child or during early years or any changes in the pattern of urination, must be evaluated by the physician.