The frequency of this malformation of urethra 1 in 50,000 newborns. At five times more common in boys epispadias. In this vice is detected cleft anterior wall of the urethra. On the front wall of the penis in boys through a hole in the wall of the channel seen the urethra and surrounding erectile tissues, which form a groove on the anterior surface of the penis.
Boys are three forms of epispadias is:
Epispadias of the glans. The front wall of the urethra is not only in the head. In this form of epispadias penis somewhat curved, and raised up to the anterior abdominal wall. The head of the penis is flat, covered by the foreskin from the bottom side only. Urination is usually not disturbed. The patient may complain of a spray of urine during urination. Erections and sexual activity nezatrudneny and erect penis takes the usual form.
Stem epispadias epispadias or penis. The front wall of the urethra in this form of epispadias is no different to the entire penis down to its foundation. Accompanied by the splitting of epispadias penile glans penis, pubic bone junction of the discrepancy, the discrepancy of the abdominal muscles. The penis is usually shortened and drawn to the stomach. The urethral opening is shaped like a funnel. Urinating urine sprayed heavily and the child is forced to hold the penis and urinate sitting down. When erect penis is deformed and sexual life impossible.
Complete or total epispadias. In this state, the front wall of the urethra is not over the entire penis, including the sphincter of the bladder. The urethra is the general form of the crater and is located just below the pubic joint. From this hopper is constantly released urine. The penis is much reduced in size. The scrotum is reduced in size, is underdeveloped. Combined total epispadias with a significant discrepancy pubic bone joint, which is manifested duck (swaying) gait. Due to the differences of the abdominal muscles belly looks like "frog" flat belly. Often the patient has congenital malformations of the upper urinary tracts, cryptorchidism, testicular hypoplasia.
The girls found:
form of clitoral epispadias when cleaved only the clitoris and above the external opening called the urethra, which is shifted upwards, it is the easiest form of urine, and when it is not broken
subsimfizarnaya form when there is a splitting of the clitoris and the labia minora
with the full split epispadias the clitoris and labia, the urethra opening is located behind the pubic joint, complete the form epispadias occurs much more frequently and is accompanied by the splitting of the pubic joint and splitting of the sphincter of the bladder, epispadias is always accompanied by a full urinary incontinence, which is constantly released from the external opening of the urethra.
Treatment of epispadias operative. Only clitoral epispadias epispadias and the glans penis, is not accompanied by urinary incontinence do not require surgical treatment. The operation is performed at the age of the child from 4 to 5 years. For a complete epispadias surgery is a two-step. First, restore the function of the sphincter of the bladder. Sphincter muscle of the bladder with complete epispadias are underdeveloped, so even when you restore the integrity of the sphincter of the bladder for more than half of the patients can not stop the incontinence. In this case, apply the operation to transplant the ureters into the sigmoid colon of antireflux procedure. A year after the restoration of bladder function, conduct the second stage of surgery - plastic urethra. It uses a channel surrounding tissue.