Presentation on Epispadias
and Hypospadias
By
OLANIPEKUN OLAWUNMI .A.
OLAGUNDOYE TOLU .P.
EVARIST BARBARA
• OUTLINE
• EPISPADIAS AND HYPOSPADIAS,
• CAUSES AND SYMPTOMS
• CLINICAL PRESENTATION
• DIAGNOSIS
• TREATMENT OPTIONS
• POTENTIAL COMPLICATIONS ASSOCIATED WITH THESE
CONDITIONS.
Epispadias and Hypospadias
Epispadias and hypospadias are both
congenital anomalies that result from
abnormal development of the urethra
during fetal development. Epispadias is
thought to be caused by failure of the
genital tubercle to fuse properly, leading
to a dorsal opening of the urethra.
Hypospadias, on the other hand, occurs
due to incomplete closure of the urethral
folds, resulting in a ventral opening.
They both occur during fetal development but epispadias
is caused by the genital opening not fusing properly
which results in urethra opening on the top while
hypospadias is caused when urethra folds don’t close
completely which leads to the urethra opening underside
instead of the tip
• Glans penis: head of the penis
• Glandular hypospadias: urethral opening on the glans penis
• Penile hypospadias: opening on the shaft of the penis
• Scrotal hypospadias: opening on the scrotum
• Penile Raphe: a ridge or seam on the underside of the penis, it occurs in
normal penile development
• Scrotal raphe: a ridge or seam that runs from the base of the penis , it occurs
in normal scrotal development
Causes and
Epispadias causes:
symptoms
1. Genetic factors: Epispadias can be inherited from one's parents, and certain genetic
syndromes can increase the risk.
2. Hormonal influences: Hormonal imbalances during fetal development can contribute to
Epispadias. Like maternal obesity, maternal diabetes
3. Environmental factors: Exposure to certain environmental toxins or substances during
pregnancy may increase the risk. Like smoking, water and air pollution
4. Bladder exstrophy: Epispadias is often associated with bladder exstrophy, a rare birth defect
where the bladder is exposed outside the abdominal wall.
Symptoms of Epispadias
5. Urethral opening on top of penis: The urethral opening is located on the dorsal (top) side of
the penis, rather than at the tip.
6. Urinary incontinence: Individuals with Epispadias may experience urinary incontinence
7. Wide, flat glans: The glans penis may be wider and flatter than usual.
8. Shortened penis: In some cases, the penis may be shorter than average.
9. Undescended testes: In some cases, the testes may not have descended into the scrotum.
10. Inguinal hernia: Some individuals with Epispadias may also have an inguinal hernia.
• Genetic syndromes like bladder exstrophy epispadias cloacal exstrophy
BEEC syndrome : genetic disorder that affects the development of the
bladder, genitalia, and anus
Urinary opening on top of the penis Urinary incontinence
Wide flat glans
Undescended testis
Inguinal hernias
Causes of Hypospadias
1. Maternal age and health: Advanced maternal age and certain health conditions, such as diabetes, may
increase the risk.
2. Family history: Having a family history of Hypospadias can increase the risk.
3. Genetic factors, Hormonal influences and Environmental factors are also causes of hypospadias
Symptoms of Hypospadias
4. Urethral opening on underside of penis: The urethral opening is located on the underside (ventral side) of the
penis, rather than at the tip.
5. Abnormal penis shape: The penis may be curved or bent due to the abnormal urethral opening.
6. Urinary spraying or dripping: Urine may spray or drip from the urethral opening, rather than flowing in a
straight stream.
7. Difficulty urinating: Individuals with Hypospadias may experience difficulty urinating or starting to urinate.
8. Increased risk of urinary tract infections (UTIs): (Hypospadias can increase the risk of UTIs due to the
abnormal urethral opening.
9. Foreskin abnormalities: The foreskin may be underdeveloped or absent.
10.Penile curvature: The penis may be curved or bent, which can affect sexual function and fertility. It's essential
to note that each individual with Hypospadias may exhibit a unique combination of these symptoms, and the
severity can vary widely.
Urethral opening on underside of penis Penile curvature
Clinical representations, Diagnosis and Treatment options
The clinical presentation of epispadias and hypospadias varies depending on
the severity of the condition. In mild cases, the abnormal urethral opening
may be located near the tip of the penis, while in more severe cases, it may
be located further back on the shaft or even on the scrotum or perineum.
Diagnosis of epispadias and hypospadias is typically made shortly after birth
during a physical examination. In some cases, imaging studies such as
ultrasound may be used to further evaluate the anatomy of the urethra and
surrounding structures.
The mainstay of treatment for both epispadias and hypospadias is surgical
repair. The goal of surgery is to create a normal-appearing urethral opening
and improve the function of the penis. The timing of surgery may vary
depending on the severity of the condition and the preferences of the patient
and their family.
Complications associated with epispadias
and hypospadias
Complications of epispadias and
hypospadias surgery can include
1. Urethral strictures
2. Fistula
3.Recurrent chordee
1. Urethral strictures are the
narrowing of the urethra,
which can lead to difficulty
with urination.
2. Fistulas are abnormal
connections between the
urethra and surrounding
structures, while
3. Recurrent chordee is the
Long-term outcomes of epispadias and hypospadias
surgery are generally good, with the majority of
patients experiencing improved urinary and sexual
function. However, some patients may require
additional surgeries to address complications or
achieve optimal cosmetic results.
Genetic factors may play a role in the development
of epispadias and hypospadias, as some studies
have suggested a familial predisposition to these
conditions. However, the exact underlying genetic
mechanisms are not well understood, and further
research is needed to elucidate the genetic basis of
these anomalies.
In some cases, epispadias and
hypospadias may be associated with
other congenital anomalies, such as
cryptorchidism (undescended
testicles), inguinal hernias, and
bladder exstrophy. These additional
anomalies may require further
evaluation and treatment to ensure
optimal outcomes for the patient.
References
Gearhart JP. Epispadias. In: Campbell-Walsh Urology. 11th ed. Philadelphia, Pa
Elsevier; 2016.
https://www.clinicalkey.com.
Accessed Feb. 10, 2021.
Borer JG. Bladder exstrophy and epispadias. Merck Manual Professional Version.
https://www.merckmanuals.com/professional/pediatrics/congenital-renal-and- genitourina
ry-anomalies/bladder-exstrophy-and-epispadias.
Accessed Feb. 10, 2021.
American Urological Association (AUA). (2020). Epispadias
American Academy of Paediatrics (AAP). (2019). Hypospadias.
Pediatric Urology. (2019). Epispadias: A Rare and Complex Anomaly.
Thanks for
Listening
