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GENITO-URINARY
DISORDER
Ms ELLEN ANGELLIN
HYPOSPADIAS
by Duckett in 1996.
He divided them into anterior (50%), middle
(30%) and posterior (20%) hypospadias.
– The anterior form: glandular, coronal and
distal penile.
– The middle form: "midshaft” and
proximal penile.
– The posterior form: penoscrotal, scrotal and
perineal
Glanular hypospadias : the urethra
is within the head of his penis
(glans).
Coronal: The opening of the urethra
is just below the head of his penis.
–Distal penile: the opening of the
urethra is in the distal portion of the
shaft of the penis
• Midshaft: The opening of the urethra is
located along the shaft of the penis.
• Proximal penile: the opening of the
urethra is in the proximal portion of the
shaft of the penis
• Penoscrotal: The opening of the urethra
is located where the penis and scrotum
meet.
• Scrotal hypospadias:
hypospadias with the urethral
opening on the scrotal surface.
• perineal hypospadias: the urethral
meatus opens in the perineum near
the anus; the scrotum is usually cleft.
Clinical manifestations
• Unknown
• Related to improper development of the pubic
bone
• Failures of abdominal and pelvic fusion in the
first months of embryogenesis
• Epispadias can be associated with
bladder exstrophy, an uncommon birth defect in
which the bladder is inside out, and sticks
through the abdominal wall
• Also occur with other defects
Classification
Classification of epispadias is based on the
location of the meatus the penis. It can be
positioned:
• On the glans (glanular)
• Along the shaft of the penis (penile)
• Near the pubic bone (penopubic).
• The position of the meatus is important
because it predicts the degree to which
the bladder can store urine (continence).
The closer the meatus is to the base of
the penis, the more likely the bladder will
not hold urine
Symptoms
In males:
• Abnormal opening from the joint between the
pubic bones to the area above the tip of the
penis
• Backward flow of urine into the kidney (reflux
nephropathy)
• Short, widened penis with an abnormal
curvature
• Urinary tract infections
• Widened pubic bone
In females:
• Further tests
• These tests may include an ultrasound scan, CT
scan, a diagnostic laparoscopy, hormonal assay
and urine and blood tests.
• Open surgery.
• Direct exploration of the abdomen or groin
through a larger incision may be necessary in
some cases.
Treatment
• It is a rare occurrence.
• The incidence of bladder exstrophy is
approximately 2.07 per 100,000 live births and is
slightly more common in males than females.
• The risk of a family having more than one child
with this condition is approximately one in
100,
• And children born to a parent with exstrophy
have a risk of approximately one in 70 of having
the condition
Etiology
• Contd……
Abnormal Development of Genitalia:
– Contd…..
• Displacement of the umbilicus and/or
an umbilical hernia.
Clinical features
•
PROMPT CLOSURE OF THE EXSTROPHIC
BLADDER
•
During this procedure the abdominal wall is mobilized
and the pubic rami are brought together in the midline.
(If the bladder closure is performed during the first 48 hr
of life, often there is sufficient mobility of the pubic rami
to allow approximation of the pubic symphysis. If the
procedure is delayed, the pelvic bones must be broken
(pelvic osteotomy) to allow the pubic rami to be brought
together and create a pubic symphysis to support the
bladder closure.)
Early bladder closure