Isolated Epispadias
Epispadias is when the urinary hole is somewhere between the pubis bone and where it should be. It occurs in both boys and girls. It is easier to identify in boys and can be described as the opening of the urethra to the upper side of the penis. There is an open groove or slit on the upper surface of the penis.
The incidence of isolated epispadias is one in 120,000 births in boys and one in 500,000 in girls. It is 4-5 times more common in boys than girls. Usually, this disease is noticed as soon as the baby is born. Sometimes it is understood that the child has epispadias after the foreskin is pulled back during circumcision.
In epispadias, the penis is shorter and thicker than normal. However, he has normal erection ability. Urinary tract is also short. Therefore, the flattened penis is pulled upwards towards the abdominal wall. Because of this withdrawal, sexual intercourse may be difficult. Whether the child will leak urine; It is closely related to how close the urinary hole is to the anterior abdominal wall and how much the muscle group we call the sphincter, which allows us to hold urine, has developed or not.
The treatment is surgery. In cases with epispadias only, operations should be performed when the baby is between 6 and 18 months of age. The aim here is to bring the urinary hole to the tip of the pipe, to correct the aesthetics and to prevent urinary incontinence. However, in some children, urinary incontinence may continue and a second surgery is needed to prevent this.
Since it is a very rare disease, the operation of the penis should be performed by experienced surgeons in order to ensure both aesthetics and function of the penis.
Exstrophy – Epispadias Complex
Exstrophy - epispadias complex is more common than isolated epispadias. The rate is one in 30,000 births.
In this group of diseases, the urinary tract, which we call the urethra, and the anterior wall of the bladder are completely open. It is a very complex and difficult disease.
There are two different views on the timing of the surgery. What I also adopt and practice is to be operated within the first 24 hours in patients with exstrophy – epispadias. Since the anterior bone, which we call the symphysis pubis, is separated in these babies, it is easier to approximate this bone in the first 24 hours of interventions. Since the risk of urinary incontinence is very high in this patient group, a second or even a third surgery is required.
Surgery is very difficult and complications are quite high. Even in skilled hands, the complication rate reaches 50%. These operations should be performed by surgeons who are experienced in genital area surgeries.