CONGENITAL ANOMALY OF GENITOURINARY SYSTEM. BY MR. DINABANDHU BARAD

1. Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU

2. CONGENITAL
ANOMALY OF
GENITOURINARY
SYSTEM
Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
BY:
Dinabandhu Barad
MSC TUTOR, SNC,SOA,DTU

3. EPISPADIASIS
Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU

4. • Epispadias is a congenital malformation in which the opening of the
urethra is on the dorsum of the penis.
• In boys with epispadias, the urethra generally opens on the top or
side of the penis rather than the tip. However, it is possible for the
urethra to be open along the entire length of the penis.
• In girls, the opening is usually between the clitoris and the labia, but
may be in the belly area.
Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
EPISPADIASIS

5. ETIOLOGY
• There are several etiological factors have been proved to be
strongly associated with Hypospadias.
• few of them are as follows :
• Genetic
• Endocrine
• environmental factors.
Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU

6. CAUSES
• Unknown
• Related to improper development of the pubic bone
• Failures of abdominal and pelvic fusion in the first months of
embryogenesis
• Epispadias can be associated with
bladder exstrophy, an uncommon birth defect in which the bladder is
inside out, and sticks through the abdominal wall
• Also occur with other defects
Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU

7. CLASSIFICATION
Classification of epispadias is based on the location of the meatus the penis. It can
be positioned:
A. ANTERIOR EPISPADIAS WITH NORMAL CONTINENCE
• On the glans (glanular)
• Along the shaft of the penis (penile)
B. POSTERIOR EPISPADIAS ASSOCIATED WITH INCOMPLETE BLADDER
NECK AND INCONTINENCE OF URINE
• Near the pubic bone (penopubic).
• Sub symphyseal
Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU

8. CLASSIFICATION
CLASSIFICATION OF EPISPADIAS IS BASED ON THE
LOCATION OF THE MEATUS IN FEMALE
A. Bifid clitoris with no incontinence of urine
B. Subsymphyseal with incontinence of urine
Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU

9. •The position of the meatus is important because it predicts the degree
to which the bladder can store urine (continence). The closer the
meatus is to the base of the penis, the more likely the bladder will not
hold urine
Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
EPISPADIASIS

10. SYMPTOMS
In males:
• Abnormal opening from the joint between the pubic bones to the
area above the tip of the penis
• Backward flow of urine into the kidney (reflux nephropathy)
• Short, widened penis with an abnormal curvature
• Urinary tract infections
• Widened pubic bone
Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU

11. In females
• Abnormal clitoris and labia
• Abnormal opening where the from the
bladder neck to the area above the normal
urethral opening
• Backward flow of urine into the kidney
(reflux nephropathy)
• Widened pubic bone
• Urinary incontinence
• Urinary tract infection
Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU
SYMPTOMS

12. DIAGNOSTIC MEASURES
• Prenatal diagnosis - rare
• Blood test to check electrolyte levels
• Intravenous pyelogram (IVP), a special x- ray of the kidneys,
bladder, and ureters
• MRI and CT scans, depending on the condition
• Pelvic x-ray
• Ultrasound of the urogenital system
Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU

13. TREATMENT
The primary goals of treatment of epispadias are to:
• maximize penile length and function by correcting dorsal bend
and chordee; and
• create functionality and cosmetically acceptable external genitalia with
as few surgical procedures as possible.
• If the bladder and bladder neck are also involved, surgical
treatment is required to establish urinary continence and
preserve fertility.
Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU

14. SURGERY
Management of epispadias is done by the surgical correction usually in
three stages:
1. First stage of surgery is done in about 1.5 to 2 years of age for
• penile lengthening
• Elongation of the urethral strip
• Chordee correction
Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU

15. SURGERY
Management of epispadias is done by the surgical correction usually in
three stages:
2. Second stage operation is done at least 6 months after the first stage
surgery for urethral reconstruction
Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU

16. SURGERY
Management of epispadias is done by the surgical correction usually in
three stages:
3. The third stage surgery is done about 3-4 years of age for bladder neck
reconstruction .
Cystoplasty can be done to enhance the bladder capacity after 2-3 years
of 3rd stage surgery .
Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU

17. NURSING CARE
• Prevention of infection
• Emotional support for long-term management
• Routine pre and post operative management
• Health maintenance
• Promotion of growth and development by balance diet
• Immunization
• Hygienic measures
• Parental guidance
Mr. Dinabandhu Barad, MSC TUTOR, SNC,SOA,DTU