Epispadias - Causes, Symptoms and Treatment .MF .
epispadias - is a congenital malformation of the external genitalia, when the external opening of the urethra opens above its normal position, for example boys - on the upper surface of the body of the penis or the pubic.
Much more rarely epispadias common in girls, and one girl shown at 565,000 compared to 1 case per 100,000 boys.
epispadias epispadias is a type of congenital malformations of the genitourinary system in newborns.Today, the company is actively working not only to study the treatment and diagnosis of the disease, but also to ascertain the immediate cause of the anomaly.It should be noted that despite the high level of medicine, to name the exact causes of epispadias are not in any foreign urological clinic.
At the same time, allocate a number of factors, which may in some way or another to increase the risk of having a child with a similar anomaly.First of all, such factors include the need to ionizing radiation, which are under the influence of the people living near nuclea
If contaminated areas in our country is not too much, smoking mothers more.And according to some reports, smoking and drinking alcohol during pregnancy on the fetus have not less negative impact than a toxic dose of ionizing radiation.
not yet fully demonstrated the influence of chronic stress and trauma on fetal development, but some scientists actively adhere to this thought, and continue to promote it among pregnant women.
Unlike similar disease, hypospadias, this malformation of the urethra can not proceed in a hidden form.One way or another, but if the urethral opening is located on the upper surface of the boy's sexual member of the body, not to notice the anomaly, even in the neonatal period, it is simply impossible.It is noteworthy, first of all, the character of the urine stream, which is directed not down, as in healthy children and up.By arranging the opening of the urethra pubic penis does not substantially participate in the act of urination.In this case, urine is released, in fact, on the baby's tummy and, flowing down, irritate the skin of genitals and perineum.
When inattentive examination, if not detected the wrong location of the urethra, skin irritation can be confused with conventional diaper rash, which is also manifested by redness of the skin of the external genitalia and perineum.Parents are beginning to use baby powder, which in this situation are ineffective.In the absence of normal treatment, the inflammation can pass in purulent stage that ends with rejection of the skin and the formation of deep ulcers.
Typically, the disease will make its debut with the birth of the child.At the same time the baby becomes restless, capricious, not gaining weight, he refuses the breast and often wakes up at night.
girls is partial and complete.In partial epispadias the clitoris is split or not, there is a discrepancy between the labia majora in the pubic area (no anterior commissure of the labia), the labia are underdeveloped, the external opening of the urethra is localized under the symphysis pubis.When incontinence external opening gapes and it implies the urine.In the case of complete epispadias labia majora diverge widely from the pubis and nezamykayut sex gap, showing signs of underdevelopment of the anterior abdominal wall and the difference ki pubic bone.The clitoris is absent.Log into the bladder, located in the area of the pubic symphysis, yawns, stretches and easily passes the finger freely.The urine flows out continuously, causing changes in the adjacent skin.
If a child has a similar general symptoms, which is accompanied by irritation of the skin in the vulva, it is necessary to show the urologist.The skilled person will be able to properly diagnose and determine the optimal treatment strategy to ensure that in future the boy did not suffer from erectile dysfunction and infertility.
As a rule, one of the clinical picture is enough to make a diagnosis epispadias.If you watch the baby while urinating, you will notice that the urine does not stand out from the normal urethra, and of pathological opening located on the upper surface of the body of the penis, or at all, the pubic.
However, for the purpose of differential diagnosis and for the proper carrying out of surgery, the diagnosis must be confirmed by additional research methods.The most common and therefore the most accurate epispadias verification method - a contrast urethrography.To do it in the cavity of the bladder by a urethral catheter is introduced contrast agent, and in the act of urination is performed X-ray examination of the penis and the pelvic organs in the lateral projection.The picture shows quite clearly seen as the self bladder, and urethra form.Most often, it just opens in the wrong place, but there are also cases when the urethra has additional moves, blindly ending in the thickness of the penis.It is for them to identify and radiological diagnostics should be carried out.
correction of this anomaly is possible only by the operative method.The volume of transactions depends on the form epispadias.If the opening of the urethra, the boy opens on the body of the penis, near the urethra, in such a situation it is possible to conduct the urethra plastics own tissues.After excision of the abnormal hole, you move the stump of the urethra in the right place and then sew it.
In short stump of the urethra or in severe epispadias when the urethra is above the pubic bone, it is necessary to perform plastic surgery using synthetic implants.
must be remembered that if at the time of surgery the patient is present irritation and redness of the external genitalia, the operation should be postponed.Primarily in this situation it is necessary to cure a local skin inflammation.To do this, apply antiseptic solutions such as chlorhexidine, which are applied to the affected surface after each urination.
Surgical treatment of epispadias
If absolute contraindications to surgery, which caused severe diseases of internal organs or refusal of treatment by parents, the sick used conservative tactics.It is aimed primarily at preventing purulent inflammation of the skin around the opening of the urethra.This is achieved by a toilet of external genitals after each act of urination and treatment of the affected area of skin antiseptic solutions.
Girls and Women indication for surgery when epispadias is only incontinence, so the main purpose of plastic surgery - the creation of the closing device.
disease in the surgical treatment of pathology rehabilitation aimed at preventing secondary infection of wounds and fractures formed anastomosis.For the prevention of infection by the ordinary antibiotic therapy.Since such an operation will not be opened any human body cavity, a single antibiotic is usually sufficient for the effective destruction of pathogens.
Prevention of anastomotic leak carried staging a conventional urinary catheter.It not only removes urine from the bladder, but also plays the role of a certain frame, thanks to which the new urethra is formed correctly.
Feeding habits and way of life
Correction diet is to limit the use of large amounts of fluid, thereby increasing the level of daily urine output, which also negatively affects the functional state of the urethral anastomosis.
Among lifestyle correction can be identified, except that only the wearing of a urethral catheter.But, given the fact that the operation at such pathology is usually carried out in the neonatal period, it is not particularly affect the patient's health.In turn, the parents need to teach me a urethral catheter and administered it in the cavity of the bladder antiseptic solutions.This is done to prevent bedsores urethra, as well as secondary prevention of cystitis.
Treatment folk remedies
Because the only way to correct this anomaly of a surgical intervention, folk treatments lose their relevance.A variety of teas chamomile and other herbs that are often recommended by traditional healers have only a local anti-inflammatory effect.It takes some time to skin irritation, but does not eliminate the primary cause of the disease.
More than once been said that the most common complication of epispadias is a maceration and inflammation of the skin around the opening of the urethra.Normally, it opens on the mucous membrane of the glans penis, which is in contact with the urine does not have one negative effect.It has no such skin barrier capabilities, so permanent impact on her urine leads to rapid destruction of the epidermis and inflammation of its deeper layers.In poor health, to this clinical condition quickly joined by a bacterial infection that ends with purulent inflammation.The lack of treatment at this stage may face common septic phenomena, and even fatal.
next group epispadias complications can be regarded as mental disorders.They develop when the correction of pathology have not been performed in the neonatal period.With age, children begin to notice his inferiority that often develops into psychological complexes, related to sexuality.Even after the surgery at an older age is rather strong psychological block, which does not allow a man to meet a woman and start a family.
profilaktirovat any congenital malformations is extremely difficult, because there is still not exactly known the cause.Only then we can say for sure that the rejection of the use of alcohol and smoking during pregnancy reduces the risk of development of a child with epispadias several times.The same applies to a pregnant woman stay in an area with high levels of radiation.
order to exclude the possibility of septic complications and prevent mental disorders in children, epispadias need to diagnose at an early stage.In principle, this should make a neonatologist still in the maternity ward.But often there are situations when the pathology is passed experts.So here it requires more vigilance and parents.As already mentioned, if the child is marked deterioration of general condition, and at the same time he is present in the skin irritation panty area, it is a potential customer pediatric urology.
Ed.urologist, sexologist-andrologist Plotnikov AN