EPISPADIASIS – Causes, Clinical Manifestation, Diagnostic Evaluations, Treatment and Nursing Diagnosis
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EPISPADIAS – Causes, Clinical Manifestation, Diagnostic Evaluations, Treatment and Nursing Diagnosis

EPISPADIASIS – Causes, Clinical Manifestation, Diagnostic Evaluations, Treatment and Nursing Diagnosis

Epispadias is a rare congenital (present from birth) defect in the location of the opening of the urethra. In this condition, the urethra does not develop into a full tube and the urine exits the body from an abnormal location

CAUSES OF EPISPADIAS

The causes of epispadias are unknown at this time. It may be related to improper development of the pubic bone.

In boys with epispadias, the urethra generally opens on the top or side (rather than the tip) of the penis, though it is possible for the urethra to be open the entire length of the penis. In girls, the opening is usually between the clitoris and the labia, but may be in the abdomen.

Epispadias can be associated with bladder exstrophy, an uncommon birth defect in which the bladder is inside out, and sticks through the abdominal wall. However, epispadias can also occur with other defects. Epispadias occurs in 1 in 117,000 newborn boys and 1 in 484,000 newborn girls. The condition is usually diagnosed at birth or shortly thereafter.

 CLINICAL MANIFESTATION

In males:

  • Abnormal opening from the joint between pubic bones to the area above the tip of the penis
  • Backward flow of urine into the kidney (reflux nephropathy)
  • Bladder exstrophy (may or may not be present)
  • Short, widened penis with an abnormal curvature
  • Urinary tract infections
  • Widened pubic bone


 

In females:

  • Abnormal clitoris and labia (Bifid clitoris, rudimentary labia)
  • Abnormal opening from the bladder neck to the area above the normal urethral opening
  • Bladder exstrophy (may or may not be present)
  • Backward flow of urine into the kidney (reflux nephropathy)
  • Widened pubic bone
  • Urinary incontinence
  • Urinary tract infections


 

DIAGNOSTIC EVALUATIONS


  • History taking and physical examination
  • Cytoscopy
  • Complete blood count
  • Serum 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


 

TREATMENT

Surgical repair of epispadias is recommended in patients with more than a mild case. Leakage of urine (incontinence) is not uncommon and may require a second operation.

Surgery generally leads to the ability to control the flow of urine and a good cosmetic outcome



NURSING DIAGNOSIS


  1. Ineffective sexual pattern r/t urethra opens on the under surface of penis and curved penis
  2. Anxiety related to surgery
  3. Knowledge deficit related to disease condition
  4. Risk for urinary tract infection related to reflux of urine back to urinary bladder