Understanding Epispadias and Bladder ExstrophyNurture Fertility Center – Specialized Pediatric Urology Care

Epispadias is a rare congenital condition where the urethra—the tube that carries urine out of the body—does not develop into a fully enclosed channel. As a result, urine exits from an abnormal opening. This anomaly is seen in approximately 1 in 117,000 male and 1 in 484,000 female newborns.

Epispadias is frequently associated with Bladder Exstrophy, a related birth defect where the bladder is exposed through the abdominal wall. Nearly all boys and most girls with bladder exstrophy also have epispadias.

How Epispadias Affects Boys

In males, the urethral opening may appear on the top or side of the penis instead of at the tip. The penis may also appear short, broad, and curved (a condition known as chordee).

Common Symptoms in Boys:

• Abnormal urine stream or spraying

• Frequent leakage during activities like coughing or laughing

• Recurring urinary tract infections (UTIs)

Types of Epispadias in Boys:

The condition is classified based on the location of the urethral opening:

• Glanular Epispadias – Opening at the tip of the penis (mildest form)

• Penile Epispadias – Opening along the shaft (moderate severity)

• Penopubic Epispadias – Opening near the pubic area (more severe, often impacts continence)

How Epispadias Affects Girls

Though less common, epispadias in girls involves an abnormal opening between the clitoris and the labia. It may result in:

• Atypical appearance of the external genitalia

• Difficulty with bladder control

• Recurrent UTIs

Differentiating Epispadias from Hypospadias

While both are urethral birth defects:

• Epispadias: Opening on the top or side of the penis (in boys) or between clitoris and labia (in girls)

• Hypospadias: Opening on the underside of the penis or near the perineum in girls

Possible Causes

Though the exact cause remains unclear, contributing factors include:

• Abnormal development of the pubic bones

• Hormonal disruptions during fetal growth

• Genetic and environmental influences

• Embryological errors affecting the cloacal membrane

Diagnosis

Epispadias is usually diagnosed shortly after birth during a physical examination. Additional tests may include:

• Ultrasound – To assess the urinary system

• Intravenous Pyelogram (IVP) – For imaging the kidneys, bladder, and ureters

• Blood Tests – To check kidney function and electrolyte levels

• MRI or CT scans – In complex cases

• Pelvic X-ray – Especially when bladder exstrophy is suspected

Prenatal Detection: While rare, signs of bladder exstrophy may be noted on advanced prenatal ultrasounds, raising suspicion for epispadias. A definitive diagnosis is typically made after birth.

Treatment & Surgical Options

Surgery is the primary treatment for epispadias and aims to:

• Reconstruct the urethra for normal urination

• Correct penile curvature (in boys)

• Restore normal genital appearance

• Improve urinary continence

• Preserve fertility and sexual function

Surgical Techniques for Boys:

1. Cantwell-Ransley Repair – Utilizes existing urethral tissue and skin to reconstruct the urethra

2. Mitchell Repair – Employs bladder lining to create a new urethra and reshape the penis

Surgical Options for Girls:

• Urethral Reconstruction – Repositions the opening to its correct location

• Correction of Genital Abnormalities – Restores the structure of the clitoris and labia

• Continence Improvement – Strengthens bladder function to reduce leakage

Surgical plans are personalized based on the child’s anatomy and condition severity.

Post-Surgery Recovery

Recovery time varies depending on the surgical method. Hospital stays usually last from a few days to a week, and full healing may take several weeks to a few months. Ongoing follow-up is crucial to ensure proper healing and development.

Outlook & Long-Term Care

With timely and expert care, children with epispadias often lead healthy, active lives. However, some may experience:

• Continued urinary leakage

• Recurrent infections

• Sexual function concerns in later years

Regular consultations with a pediatric urologist are essential for long-term monitoring.

Risks and Complications of Surgery

As with any surgical procedure, potential risks include:

• Bleeding or infection

• Narrowing of the urethra (stricture)

• Fistula formation

• Incontinence

• Need for additional surgeries

In most cases, circumcision is not recommended for boys with epispadias, as the foreskin may be needed for reconstruction.

Fertility and Sexual Health

While epispadias does not typically impair erectile function, abnormalities in testicles or sperm ducts could impact fertility in some cases. Regular urological evaluations are important to address these possibilities early.

Support and Guidance from Nurture Fertility Center

At Nurture Fertility Center, we are committed to providing expert diagnosis, surgical care, and compassionate support for children with urological birth conditions like epispadias. We emphasize early intervention, personalized treatment, and family-centered care to ensure the best outcomes for your child.

For any concerns regarding your child's urinary health, contact our team of pediatric specialists for a thorough evaluation and guidance.

Your child’s health is our priority. Trust Nurture Fertility Center for comprehensive care and lifelong support.