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Epispadias occurs when the urethral opening (the tube that drains the urine from the bladder to the outside of the body) is not in the correct location. Epispadias can occur alone, but usually occurs in conjunction with bladder exstrophy, which is a combination of disorders that occurs during fetal development.
When this condition occurs in boys, the urethra opens on the top side of the penis, instead of at the tip. In girls, the urethral opening is bigger and longer than normal, positioned further up the urethral tube, and can extend all the way to the bladder.
The causes of epispadias are not known. It may occur because the pubic bone does not develop properly.
Epispadias is a very rare congenital defect affecting 1 in 117,000 newborn boys and 1 in 484,000 newborn girls.
Learn about the Department of Pediatric Urology at Children's Hospital Colorado.
In boys, the penis is typically short and broad and the urethral opening is located on the top side of the penis. From the location of the abnormal opening to the tip, the penis may be split. There may also be an abnormal curvature of the penis toward the abdomen.
Girls will have a narrow vaginal opening, wide labia, split clitoris and a short urethra. Wide pubic bones, urinary tract infections, urinary incontinence and reflux of urine into the kidneys are also symptoms of epispadias.
The diagnosis of epispadias typically happens at birth. If the malformation is not severe, it may be diagnosed when the child (usually female) continues to have wetting after potty training. A pediatric urologist should be consulted when you or the child’s pediatrician have any concerns about the genitourinary tract appearance or function.
This diagnosis is made by physical examination at birth. In addition, it is usually necessary to perform an ultrasound scan of the kidneys and an x-ray of the pelvis and pelvic bones.
The primary goal of treatment is to create typical-looking external genitalia that functions well.
In boys, surgical treatment is performed to maximize penile length and function by correcting the bend in the penis and moving the urethra so the boy pees from the end of the penis.
In girls, this means fusing the clitoris, moving the urethra and repairing the bladder’s control mechanism to prevent urinary leaking.
At Children’s Hospital Colorado, we have an experienced multidisciplinary team that is used to helping children with complex urological problems. Our experienced urologists were trained in centers with worldwide reputations for treating epispadias.
Urologists work closely with the orthopedic department at Children’s Colorado to resolve orthopedic concerns that epispadias patients have. In addition, we have set up support groups to help patients come to terms with the complex issues they may face as they go through childhood into adulthood.