Epispadias
| Classification according to ICD-10 | |
|---|---|
| Q64.0 | Epispadias |
| ICD-10 online (WHO version 2019) | |
As epispadias (of gr. Ἐπί: about σπαδόν: column) or upper urethra cleavage ( fissure superior urethra ) refers to a congenital malformation , in which the urethra at the top of the penis opens. The opposite, the mouth of the urethra on the bottom of the penis is known as hypospadias .
root cause
The cause is a partial developmental disorder of the cloacal membrane . However, this is less pronounced than with bladder exstrophy .
Findings and diagnosis
Epispadias can be seen with the naked eye, it is a so-called "eye diagnosis". Depending on the location of the urethral opening, the clinical picture can be graded. For this purpose the attributes
- glandis (urethral mouth on the glans penis, but dorsal to the loco typico ),
- coronaria (in the Corona glandis),
- penis (on the penis shaft),
- pubis (above the base of the penis) and
- totalis (open bladder - see also bladder exstrophy )
used.
Other anomalies such as the dorsal curvature of the penis or a dorsally split foreskin can also occur associated with epispadias. Urinary incontinence is typically associated with an epispadia pubis because the bladder sphincter (and possibly also the symphysis ) have not grown together, i.e. split.
In the presence of epispadias, additional diagnostic sonography and excretory urogram are recommended as basic diagnostics .
Disease value
As a rule, in contrast to hypospadias, the focus here is less on the cosmetic aspects than on the functional aspects such as incontinence (in the case of severe), pain during erection and impotentia coeundi due to a shortening of the pars pendulans of the penis. Mental disorders are also often associated with it.
therapy
To correct the malformation, surgical penis and urethral plastic surgery in the 1st – 4th Year of life possible. In the case of incontinence, a reconstruction of the urinary bladder sphincter is attempted in the third year of life ; if this is unsuccessful, other forms of urinary diversion are required.
Individual evidence
- ↑ a b c d A. G. Hofstetter among others: Urology for the practice. Bergmann Verlag, ISBN 3-8070-0351-7 , pp. 183-184.
- ↑ J. Langmann: Medical Embryology. Thieme, ISBN 3-13-446606-6 , pp. 176-203.
- ↑ a b Ch. P. Speer: Pediatrics . Springer, 2005, ISBN 3-540-20791-0 , pp. 868–869 (online at: books.google.de )
