Epispadias: Symptoms, Treatment Options, Cases

This video is about epispadias - a congenital anomaly which is characterized by short phallus with marked upward curvature. The problem can also include the bladder and large intestine. The degree of affecting genitalia in epispadias varies.

In affected boys, the penis is typically broad, shortened and curved toward the abdomen. The penis is attached to the pelvic bones, which are widely separated, resulting in a penis that is pulled back toward the body.

Classification of epispadias is based on the location of the urethral meatus. It can be positioned on the glans, along the shaft of the penis or near the pubic bone. The position of the meatus is very important, predicting the capacity of the bladder to store urine. The closer the meatus is to the top base of the penis, the more likely the bladder will not hold urine.

The primary goals of treatment of epispadias are: to lengthen and straigthen the penis by correcting dorsal bend and chordee; and create functional 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.

There are two popular surgical techniques that achieve these objectives. The first is the modified Cantwell technique, which involves partial disassembly of the penis and placement of the urethra in a more normal position.

The second technique and most recent evolution of the modern epispadias repair is the complete disassembly of the penis into its separate components - two corpora cavernosa and a single corpus spongiosum. Following disassembly, the three components are reassembled such that the urethra is in the most functional and normal position and dorsal chordee is corrected. Both techniques provide a straight urethra positioned on the underside of the penis, correction of chordee and an acceptable cosmetic result. The disassembly technique has a lower complication rate and facilitates bladder and bladder neck repair.