A case report on continent isolated male epispadias.

Abstract

<jats:p>Epispadias is a rare congenital anomaly in which the urethral opening is on the dorsal surface of penis. Its incidence is 1 in 117000 newborn males and 1 in 484000 in newborn females. Its etiology is considered as because of failure of medial migration of mesenchyme between the ectodermal and endodermal layers of cloacal membrane due to premature rupture of cloacal membrane. Epispadias often presents as exstrophy epispadias complex, a wide spectrum of abnormalities that consist of classic bladder exstrophy, Epispadias and cloacal exstrophy. This case was not a part of exstrophy epispadias complex and it was an isolated continent epispadias which is extremely rare and it was managed with Cantwell Ransley epispadias repair technique.</jats:p>

Isolated Male Epispadias with Continence in a 40 Year Old: A Case Report

“…Generally the phallus is broad and short with a dorsal chordee, an open urethral plate and absent dorsal foreskin in the male child, while in the female child, it presents as a bifid clitoris and labia minora. This is contrary to the case in hypospadias, where the meatus lies ventrally on the penile shaft [1,4,7].…”

“…Epispadias is rare with an incidence rate of 1 in 117,000 live births in males and 1 in 1,300,000 live births in females [1,2,5,6]. Epispadias is associated with many co-exisiting congenital conditions such as vesicoureteric reflux (VUR), bladder exstrophy, urinary incontinence and inguinal hernia [4,7]. The incidence of co-existing VUR is 30 -75% and of inguinal hernia is 35% [7].…”

“…Epispadias is associated with many co-exisiting congenital conditions such as vesicoureteric reflux (VUR), bladder exstrophy, urinary incontinence and inguinal hernia [4,7]. The incidence of co-existing VUR is 30 -75% and of inguinal hernia is 35% [7]. The vast majority of epispadias that occur in association with bladder exstrophy are classified as non-syndromic.…”

“…Epispadias is typically diagnosed at birth in the male child, but in the female it may go unrecognized, until the girl experiences persistent urinary incontinence after toilet training or recalcitrant urinary tract infection [1,7]. Generally the phallus is broad and short with a dorsal chordee, an open urethral plate and absent dorsal foreskin in the male child, while in the female child, it presents as a bifid clitoris and labia minora.…”

“…The diagnosis of epispadias is clinical, but most of the time plain x -ray is required to assess the orientation of the pelvic bones, and ultrasonography to assess the upper urinary tract for concomitant renal anomalies. A micturating cystourethrogram is useful in evaluating the bladder capacity as well as the presence of vesicoureteric reflux [7]. Managing epispadias poses a great challenge and its treatment is mainly surgical, involving bladder closure, urethral reconstruction and osteotomies if pubic diastasis is present [4,7].…”