Hypospadias & epispadias
Hypospadias and epispadias are congenital conditions that affect the urethra of males, and rarely, females. Both involve abnormal placement of the urethral opening and can have implications for urination, sexual function, and fertility if not corrected. Here’s a detailed look at each condition:
Hypospadias
Definition and Incidence: Hypospadias is a condition where the urethral opening is located on the underside of the penis rather than at the tip. It is one of the most common congenital anomalies in males, occurring in about 1 in every 200-300 live male births.
Causes: The exact cause of hypospadias is not fully understood, but it is believed to involve a combination of genetic and environmental factors. Hormonal imbalances or disruptions during fetal development, particularly involving the action of male hormones, are thought to play a role.
Symptoms:
Misplaced urethral opening, which can be anywhere along the penile shaft, behind the scrotum, or in the perineum.
Curvature of the penis (chordee), which is often associated with more severe forms of hypospadias.
Hooded appearance of the foreskin, where the foreskin is developed only on the top half of the penis.
Difficulty directing the urine stream, potentially causing spraying or dribbling during urination.
Treatment: Treatment generally involves surgery to reposition the urethral opening to its correct location at the tip of the penis, correct any penile curvature, and if necessary, modify the foreskin. The procedure is typically performed when the child is between 6 and 18 months old, under general anesthesia.
Epispadias
Definition and Incidence: Epispadias is a rare urogenital malformation where the urethra opens on the upper aspect of the penis. It is less common than hypospadias, occurring in about 1 in 120,000 births. Epispadias can occur on its own or as part of a more complex condition known as bladder exstrophy.
Causes: Like hypospadias, the causes of epispadias are not well understood but are thought to be related to abnormal development of the pubic bone during fetal growth.
Symptoms:
Placement of the urethral opening on the top side of the penis, near the base of the penis in more severe cases.
Possible curvature of the penis upwards.
Continence issues, as the condition can affect the sphincter muscles involved in controlling urination.
Issues with sexual function and fertility in severe cases.
Treatment: Surgical correction is also the treatment for epispadias. The goals are similar to those of hypospadias surgery: to achieve a cosmetically normal penis, with the urethra ending at the tip, and to ensure proper function for urination and, later in life, sexual activity. In cases associated with bladder exstrophy, additional surgical procedures may be required to reconstruct the bladder and abdominal wall.
Commonalities and Differences
Both conditions require early diagnosis and specialized pediatric urological care to plan the appropriate treatment and surgery. The timing and complexity of surgery can depend on the severity of the condition. Postoperative care is crucial and may involve follow-up surgeries to optimize cosmetic and functional outcomes.
Hypospadias and epispadias both have significant implications for physical and psychological well-being, making comprehensive care, including emotional and psychological support, essential for affected individuals and their families.