EPISPADIA AND HYPOSPADIA

Question 1

Epispadia definition

Answer 1

is the congenital abnormal opening of the urethral meatus on the dorsal surface of the penis proximal to the tip ofthe glans

Question 2

Hypospadias definition

Answer 2

is the congenital abnormal opening of the urethral orifice anywhere along the urethral length on the ventral surface of the penis proximal to the tip of the glans

Question 3

Associated Conditions:

Answer 3

Inguinal hernia, undescended testis, extrophy of bladder, urinary incontinence

Question 4

Pathological features of Epispadia

Answer 4

*Absence of meatus at glans-tip
*Dorsal urethral opening
*Dorsal groove distal to abnormal *meatus Ventral hooded prepuce

Question 5

Pathological f e a t u r e sof Hypospadia

Answer 5

*Ventral urethral meatus; proximal to tip of glans
*Dorsal hoody of the prepuce
Splayed and flattened glans (spade-like)
Absence of meatus at the tip of glans Median grooved atretic distal urethral plate Chorded ventral curvature of penis
Bifid scrotum

Question 6

Investigations

Answer 6

Diagnosis is essentially clinical
-General:FBC (anemia), leukocytosis (infection), E/U/Cr (renal involvement), blood grouping and cross matching, Urine m/c/s (UTI)
-Specific: karyotyping, Barr body, abdominopelvic ultrasound scan

Question 7

Treatment

Answer 7

Definitive treatment is surgery with the aim of ensuring good urinary stream and copulation. It is achieved through:
-orthoplasty -meatoplasty
-urethroplasty - s c r o t o p l a s t y
-Skin cone

Question 8

Surgical techniques

Answer 8

a. Meatoplasty: Meatal
Advancement
with glanuloplasty incorporated
b.Urethroplasty:
Matthieu repair
(distal hypospadias),
Duckelt repair
(proximal hypospadia)
C. Pechele flap