SHRI SWAMI BHUMANAND COLLEGE OF NURSING

RANIPUR JHAL , JWALAPUR , HARIDWAR

ASSIGNMENT
ON
EPISPADIASIS

SUBMITTED TO:- SUBMITTED BY:-

MISS- RAJNI MISS PRIYANJALI SAINI

NURSING LECTURER MSc (N) 2ND YEAR

SSBCON

SUBMITTED ON:- 24/04/2020

 ANATOMY OF URINARY SYSTEM:-

The urinary tract is like a plumbing system. It has special "pipes" that allow
waste to flow through. The urinary tract is made up of 2 kidneys, 2 ureters,
the bladder, and the urethra.

The kidneys act as a filter system for the blood. They remove toxins and
keep useful protiens, sugar, salts, and minerals. Urine is the waste product.
It is made in the kidneys and flows down two, 10 to 12-inch-long tubes called
ureters. The ureters are about a quarter inch wide and have muscled walls.
They push urine into the bladder.

The bladder can swell to store the urine until you're ready to drain it. It also
closes the path so urine can't flow back into the kidneys.

The tube that carries urine from the bladder out of the body is called the
urethra.

In males, the urethra is long. It starts at the bladder and runs through the
prostate gland, perineum (the space between the scrotum and the anus),
and penis.

In females, the urethra is much shorter. It runs from the bladder in front of
the vagina and opens outside the body.

Urethra has muscles called sphincters. The sphincter complex (also called
the bladder neck) is a ring-shaped muscle wrapped around the urethra. The
help keep the urethra closed so urine doesn't leak before you're ready.
These sphincters open up when the bladder contracts so you can release
urine.
Female urinary tract
EPISPADIAS:-

 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.

INCIDENCE:-

 Epispadias occurs in 1 in 117,000 newborn boys and 1 in 484,000

newborn girls.

CAUSES:-

 unknown
 Related to improper development of the pubic bone.
 Failure of abdominal and pelvic fusion in the first month of
embryogenesis
 Epispadias can be associated with bladder exstrophy, an uncommon
birth defect is inside out, and sticks through the abdominal wall.

CLASSIFICATION:-

 IN MALES:- epispadias is classified based on the location of the

meatus on the penis.
 glandular epispadias: it is found on the head of the penis
 penile epispasias : it is found along the shaft of the penis
 penopubic epispadias: it is found or near the pubic bone
 IN FEMALES:- epispadias can be classified as-
 Bifid clitoris with no incontinence of urine.
 Subsymphyseal with incontinence of urine.
 CLINICAL MANIFESTATION:-

IN MALES:

 Abnormal opening from the joint between the pubic bone to the area
above the tip of the penis
 backward flow of the urine into the kidney
 short, widened penis with an abnormal curvature
 urinary tract infection
 widened pubic bone

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
 widened pubic bone
 urinary incontinence
 UTI

DIAGNOSTIC EVALUATION:-

 prenatal diagnosis
 blood test to check electrolyte levels
 IVP-INTRAVENOUS PYELOGRAM- A special x-ray of the kidney ,
bladder and ureters.
 MRI and CT scans, depending on the condition
 pelvic x-ray
 ultrasound of the urogenital system

SURGICAL TECHNIQUE:-

 IN MALES:-
  The modified cantwell technique- it involve parital disassembly of
the penis and placement of the urethra in a normal position.
 The Mitchell technique- it involves taking the penis apart
completely , then putting it back together.
 IN FEMALES-reconstruction in girls is less complex than in boys.

TREATMENT:-

The primary goals of treatment of epispadias are to:

 Maximize penile length and function by correcting dorsal bend

 Create functionally and cosmetically acceptable external genitalia with
a 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.

The second technique is Mitchell technique:-

 It involves complete disassembly of the penis into its three separate

components.
 Following disassembly , the three components are reassembled such
that the urethra is in the most functional and normal position and dorsal
chordee is corrected.

Supportive nursing care.