Chapter 31: Hypospadias and Epispadias (Children)

Question 1

Hypospadias and Epispadias

Answer 1

-possibly congenital conditions that imply an abnormal positioning of the urethral meatus in boys

Question 2

Hypospadias

Answer 2

the meatus is inferior to its usual position

• may cause chordee, which is a bending of the penis that may present problems with intercourse
• may not be able to urinate standing
• may be associated cryptorchidism

Question 3

Epispadias

Answer 3

the meatus is superior to its usual position, and a surgical correction with possible penile urethral lengthening may be necessary

Question 4

Signs and Symptoms of Hypospadias

Answer 4

• opening of the urethra below the tip on the bottom side of the penis (on the underside of the penis rather than the tip)
• incomplete foreskin
• curvature of the penis during erection
• abnormal position of the scrotum in relation to the penis

Question 5

Signs and Symptoms of Epispadias

Answer 5

• opening of the urethra above the tip of the penis
• curvature of the penis
• urinary incontinence

Question 6

Diagnosis

Answer 6

-based on patient history, physical examination findings, radiography, and ultrasound

Question 7

Prevention

Answer 7

nurses must be aware of potential voiding dysfunction and chordee issues (bending on the penis)

Question 8

Nursing Care

Answer 8

• assist the mothers and fathers with dealing with feelings over possibly causing the disorder (may be b/c of in vitro fertilization, fertility drugs or low-birth weight)
• prepared to counsel parents who are upset about their child’s congenital defects and need for surgery

Question 9

Surgical Care

Answer 9

• usually performed during the second 6 months of the boy’s life and before toilet training
• circumcision cannot be done until after this surgery b/c the foreskin may be used in the repair
• techniques reconstruct the penis to lengthen the urethra and bring it to the distal penis shaft; the chordee is straightened, and often foreskin is used as a graft, so children born with hypospadias cannot be circumcised
• may have urethral stent or Foley catheter in place to allow urine drainage b/c of potential obstruction of voiding from surgical edema
• a compression dressing termed penile wrap may be used

Question 10

Nursing Care Post-operatively

Answer 10

• observes for swelling (some is expected), hematoma, purulent discharge, fever, or erythema including possible infection
• instruct caregiver to have child soak in warm water for 20 minutes before the surgical follow-up appointment to loosen the dressing

Question 11

Potential Surgical Complications

Answer 11

• urethral fistula (an opening that allows urine to leak to the surface)
• stenosis
• return of the meatus to its original site post-surgically
• strictures at the site of the anastomosis

Question 12

Education/Discharge

Answer 12

-watch for evidence of UTI (e.g. fever, cloudy, foul urine; and hematuria)
-pediatric patients may also suffer from acute pain r/t bladder spasm, incisional pain, and pain r/t infection
>Oxybutynin chloride (Ditropan) is an anticholinergic that may relieve bladder spasm; adverse effects include dry mouth and flushed face

Question 13

Oxybutynin (Ditropan)

Answer 13

anticholinergic that may relieve bladder spasm

-adverse effects: dry mouth, flushed face

Question 14

Gynecomastia

Answer 14

breast enlargement
-temporary during puberty
-between 12 and 14 years of age
>Type 1: benign and self-limited; occurs during Tanner stages II and III; unilateral; may persist for 2 years; may be associated with imbalance in testosterone and estrogen levels or increased prolactin hormone; a 1 to 3 cm round, mobile mass may be palpated under areola
>Type II: pain gynecomastia without associated disease
>Type III: results from obesity
>Type IV: r/t hypertrophy of pectoral muscles

Question 15

Gynecomastia: What to say

Answer 15

• gynecomastia is usually a temporary condition
• if obesity is an issue, collaborate with the patient and family members to establish an age-appropriate dietary plan; dietician referral
• may be necessary to have certain blood tests to eliminate any risk of pathological causes of the gynecomastia
• discuss ways the child can respond to hurtful comments from other children
• discuss that an enlarging mass or a mass that persist more than 2 years requires diagnostic work-up to consider the differential diagnosis of breast tumor, Klinefelter’s syndrome (decreased facial hair, eunuch body, normal to borderline to low IQ, and micro-orchidism), drug-induced gynecomastia, and thyroid disease