Epispadias: Causes, Symptoms, Treatment and Cost

Epispadias is a congenital defect of the urethra. It occurs when the urethral tube does not close properly during foetal development, causing the opening to be located on the upper surface of the penis rather than at its tip.

In some cases, epispadias can also involve a malformation of the pubic bone and genitalia, such as an abnormally narrow penis or a scrotum that is split into two halves. Epispadias can affect both boys and girls and is usually diagnosed in infancy.

This disorder can be classified into three types:

• Complete Epispadias: In this type, the urethral opening is located on the dorsal or top surface of the penis and extends to the base of penis near scrotum. The foreskin or prepuce is usually absent, and there may be a wide separation between both halves of penis.
• Partial Epispadias: In this type, only part of urethra opens on top surface of penis while other part opens as normal at tip of glans. The foreskin may be present or absent in partial epispadias.
• Complex Epispadias: In this type, there are multiple openings along dorsal aspect of penis and scrotum with associated bladder malformations such as duplication and exstrophy (bladder outside abdominal wall).

It is caused by a failure in normal embryonic development, resulting from genetic and environmental factors.

These include genetic conditions such as aneuploidy or chromosomal structural abnormalities, as well as exposure to certain drugs during pregnancy.

The primary symptom of epispadias is the abnormal positioning of the urethral opening on the top or side of the penis. This can be seen at birth.Other symptoms may include:

• Abnormal shape of the penis
• Undescended testicles
• Weak urine stream
• Difficulty controlling urination
• Urinary tract infections and incontinence

Preventing Epispadias involves managing any risk factors before conception and during pregnancy. Risk factors include :

• maternal smoking,
• diabetes, and
• genetic history.
• Mothers should also take folic acid supplements prior to conception to reduce their risk for birth defects such as Epispadias.
• Additionally, pregnant women should receive regular prenatal care including ultrasound exams to monitor foetal development.

It is typically diagnosed shortly after birth by :

• Physical examination : During a physical examination, the doctor will look for signs of epispadias. This includes looking at the area where the urethra meets the penis and determining if it is located at or near the top of the penis. The doctor may also examine the foreskin and check for any deformities in the area.
• Magnetic Resonance Imaging (MRI): MRI is the preferred imaging technique for diagnosing epispadias, as it provides more detailed and clear images of soft tissue structures such as the urethra, bladder and penis.
• Ultrasound: Ultrasound is used as indicator test for this condition. However, Ultrasound is not as effective at providing detailed images of these structures.
• Urine analysis : A urine analysis as part of the diagnostic workup for epispadias may include a physical examination of the urine, testing for levels of protein, glucose, and other substances.

Possible complications of epispadias include

• Urinary tract infections,
• Difficulty passing urine,
• Hypospadias (a condition where the urethral opening is located on the underside of the penis),
• Penile curvature, and
• Infertility.

Turmeric: Turmeric is one of the most widely used Ayurvedic home remedies for epispadias. It has anti-inflammatory and antiseptic properties that help in reducing inflammation and the chances of infection. To use this remedy, mix one teaspoon of turmeric powder with a cup of warm water and drink it two to three times a day.

The best diet for any person with epispadias is one that includes

• Plenty of fruits and vegetables,
• Lean proteins,
• Whole grains, and
• Healthy fats.
• Additionally, it's important to stay hydrated by drinking plenty of water throughout the day.

It is best to avoid foods that are

• High in sugar, fat and .
• Processed meats,
• Fried foods, sugary snacks
• Sugary Drinks.
• It is also important to limit or avoid caffeine and alcohol.

Surgical treatments for epispadias are divided into three major steps, which are:

• Preparing the Urethral Plate: This involves creating a new urethra by stretching, incising and suturing the existing tissue to create a tube-like structure.
• Urethroplast: This involves making an incision in the urethral plate and reconstructing the urethra using tissues from other parts of the body such as the bladder and surrounding areas.
• Anastomosis/Urethral Reimplantation: This is done to connect the reconstructed urethra back to its original location in order to restore normal urinary flow.

Non-surgical treatment may include:

• Pelvic floor physical therapy (PFPT): PFPT can help to strengthen weakened muscles and improve bladder control and urine flow.
• Urethral dilation: This procedure involves gently stretching the urethral opening with a dilator to make urination easier and more comfortable.
• Medication: Certain medications, such as alpha blockers, can help to relax smooth muscle in order to reduce urine leakage and improve bladder control.
• Urinary catheterization: A urinary catheter can be used intermittently in order to empty the bladder completely, which can help reduce symptoms such as infection or pain associated with an incompletely emptied bladder due to epispadias.
• Dietary modifications: Dietary modifications such as increased water intake or limiting foods that irritate the bladder may also be helpful for reducing symptoms related to epispadias.
• Kegel exercises: Kegel exercises involve repeatedly contracting and relaxing pelvic floor muscles, which can help improve urinary incontinence or pain associated with epispadias

To manage and treat Epispadias, it is important to consult with a Urologist or Pediatric Urologist.

The most effective medicines for Epispadias are

• Antibiotics to help prevent infection,
• Anti-inflammatory medications to reduce inflammation,
• Topical steroids to help reduce swelling.

Recovery from epispadias surgery typically takes about 4 to 6 weeks. During that time, the patient may experience some pain and discomfort and will need to follow their doctor’s instructions for wound care, pain management and activity.After surgery, the patient may be able to return to normal activities within a couple of weeks but should avoid any strenuous activity or contact sports for a few months.

The results of treatment for epispadias are often permanent. Treatment typically involves reconstructive surgery to repair the urethra and close any openings in the penis. In some cases, a catheter may be used to help with urinary function after surgery.

Follow-up care is important to ensure that the surgery was successful and no long-term complications arise. With successful treatment, patients can expect normal urination and improved sexual functioning in adulthood.

Post-surgical treatment depends on the type of epispadias repair that was performed. Generally, post-surgical care may include:

• Keeping the area clean and dry
• Avoiding strenuous physical activity for at least six weeks
• Wearing an abdominal binder for several weeks to support the surgical site
• Taking oral antibiotics to help prevent infection
• Visiting a urologist regularly to monitor healing and adjust any treatments as needed (such as medications or catheter changes)
• Scheduling regular follow-up appointments with a urologist or plastic surgeon to ensure proper healing and long term success of the operation.

The cost of Epispadias treatments in India can vary widely depending on the specific procedure needed and the hospital where it is performed. Generally, treatment for Epispadias can range from approximately Rs. 15,000 to Rs. 50,000 for single surgeries and upwards of Rs. 100,000 for complex cases requiring multiple operations. Additionally, there may be additional costs associated with hospital stays, medications and other follow-up care that need to be factored in when considering the cost of treatment.

The most common side effects of epispadias treatments include

• Infection
• Bleeding
• And scarring.

Other rare risks associated with treatment include urinary incontinence and strictures (narrowing of the urethra).

If you are suffering from any complications relating Epispadias then you should consult a doctor nearby as they can complications like 'urinary tract infections, difficulty passing urine,hypospadias (a condition where the urethral opening is located on the underside of the penis), penile curvature, and infertility. 'in which treatment course can range from a few months to years depending on the severity of the situation.