Epispadias and Hypospadias

Epispadias and Hypospadias are congenital defects involving abnormal placement of the urethral orifice of the penis.

Epispadias: Urethral orifice is located on the dorsal surface of the penis; the condition often occurs with exstrophy of the bladder.

Hypospadias: Urethral orifice is located below the glans penis along the ventral surface.

Causes of Epispadias and Hypospadias

Epispadias and Hypospadias result from disrupted fetal genital development, with causes involving a mix of genetics, hormonal issues and environmental factors during pregnancy, affecting urethral fold closure and leading to an abnormal urethral opening on the underside or top of the penis.

Sign and symptoms

• Both defects can usually be observed at birth. The nurse in the neonatal nursery observes the voiding pattern of all infants.
• Abnormal Urine steam
• Difficulty in urinating
• Recurrent urinary tract infection (UTIs)
• In later age potential sexual/ fertility issues

Treatment

Surgery is generally performed at approximately 3 years of age, some time preferably between 16 to 18 months of age. Circumcision is not performed on a newborn with epispadias and hypospadias because the foreskin may be used in surgical reconstruction of the defect. Surgery may be done in one or more stages, depending on the defect.

The child has a pressure dressing and may have some type of urinary diversion or a urinary stent (used to maintain patency of the urethral opening) while the meatus is healing. Nurse encourage fluid intake to maintain adequate urine output and maintain patency of the stent. Notify the physician if there is no urinary output for 1 hour because this may indicate kinks in the urinary diversion or stent or obstruction by sediment.

 Nurse instruct parents in the care of the child who has a urinary diversion or stent. Instruct parents to avoid giving the child a tub bath until the stent, if present, is removed. Instruct parents about fluid intake, medication administration, sign and symptoms of infection, and need for physician follow-up for dressing removal after surgery as prescribed.