Incidence:
- Complete male epispadias: 1 in 121,000 live male births
- Complete female epispadias: 1 in 400,000 live female births
Epispadias is the appearance of an open urethra on
the dorsal aspect of the penis in males. The extent of the defect
may vary from a mild glandular defect to complete defects as seen
in Classic Bladder Exstrophy.
Classification in the male is defined by the position
of the urethral meatus into glandular, penile, or penopubic variants.
All forms of epispadias are associated with dorsal chordee. The extent
of chordee is variable.
Incontinence can be seen with the penopubic variants.
In the female, the characteristic finding is one of a bifid clitoris,
flattening of the mons, and separation of the labia.
Associated defects are usually limited to the genital
tract and diastasis of the pubic bones. Reflux develops in about 40%
of patients.
Treatment:
Repair is similar to that of the second stage of
exstrophy repair. The Cantwell-Ransley technique is utilized. At times,
the extent of the defect may require a two-stage procedure. With the
reconstruction of the bladder and external genitalia, continence rates
approach 75% in males and 85% in females. Delayed continence in the
male may be noted as the prostate grows. Satisfactory intercourse
can be noted in 80% of patients with good cosmetic appearance. Fertility
can also be preserved in most patients.
Reference:
- John P. Gearhart, Robert D. Jeffs: Exstrophy
of the Bladder, Epispadias and other Bladder Anomalies in Campbell's
Urology, Sixth Edition. Eds. Walsh PC, Retik AB, Stamey TA, Darracott
Vaughan E, Jr., WB Saunders Co. Vol. 2 1772-1821.
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