epispadias
Introduction
Introduction to the upper urethra Epispadias refers to the absence or partial absence of the dorsal wall of the urethra. The urethra is open to the dorsal side of the penis. The distal end of the urethral opening is grooved. It is a rare congenital urethra deformity. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: urinary incontinence, nausea and vomiting, dehydration
Cause
Cause of urethral fissure
Causes
Dysplasia
At the 8th week of the embryo, the genital nodules that form the penis in the lower part of the anterior abdominal wall are displaced backwards, and the urogenital groove connected to the end of the genitourinary sinus is located in front, so that the urethra formed later is located on the dorsal side of the penis, such as urine. The genital tract does not meet at the midline, and the urethral fissure is formed. According to the opening position of the urethra on the dorsal side of the penis, the male urethral fissure can be divided into 3 types.
1. Penis head type: The urethra is opened before the dorsal coronal groove of the penis head.
2. Penis type: This type is most common in the urethra opening on the dorsal side of the penis, anywhere between the base of the penis and the coronal groove.
deformity
The urethra is open to the bladder neck, and some even combine with different degrees of bladder valgus and pubic symphysis. The external urinary sphincter and bladder neck muscles are insufficiency. The female urethral fissure is divided into clitoris type, pubic symphysis type and complete type. It is characterized by clitoris division, large and small labia separation, pubic bone separation, complete type with urinary incontinence.
Pathological change
1. Abnormal urethral position: located on the dorsal penis of the penis.
2. The anterior wall of the urethra has different degrees of defects: the urethra of the defect is grooved, and the urethra mucosa is covered thereon.
3. Penile malformation: the penis head is flat and wide, with a shovel-like shape, the penis is back, the corpus cavernosum is separated, the penis is short, the back of the foreskin is lacking and the ventral side is more.
4. Urethral sphincter developmental disorders: causing urinary incontinence, bladder atrophy.
Prevention
Urethral prolapse prevention
Infants and young children may cause congenital urinary diseases due to maternal infection, diet, and polluted living environment during the embryonic period. Therefore, prevention of congenital urinary diseases requires pregnant mothers to do a good job in prenatal and postnatal care, regular check-ups, and away from teratogenic factors.
In addition, congenital urinary diseases can be found through pregnancy tests during pregnancy. For example, if you check out the hydronephrosis after seven or eight months of pregnancy, it is likely to have this problem. However, the current treatment is mainly carried out after birth, and there are no reports or cases related to treatment before birth.
Complication
Urethral rupture complications Complications, urinary incontinence, nausea and vomiting
Congenital urethral malformation: a congenital anomaly that has developed before the birth of the fetus, including hypospadias, upper urethral fissure, diverticulum, posterior urethral valve, and congenital urethral stricture. Infants have severe systemic symptoms such as dysplasia, loss of appetite, nausea, vomiting and fever, and dehydration. Filled muscles or enlarged kidneys can be found during physical examination. Children over 1 year old have severe dysuria symptoms. Such as crying when urinating, laborious, and even need to press the lower abdomen by hand, can begin to urinate, weak urine flow, and sometimes overflowing urinary incontinence. There is a pain in the waist when urinating, often there is reflux of the ureter.
Symptom
Urethral rupture symptoms common symptoms urinary incontinence male sexual dysfunction urogenital sinus pubic symphysis separation
1. Abnormal urethra position and penile malformation.
2. Urinary incontinence
About 50% of patients with urethral fissure have urinary incontinence. The severity of urinary incontinence mainly depends on the degree of defect in the anterior wall of the posterior urethra. The complete type has urinary incontinence. When the penis body is open under the pubic symphysis, it can be stressed. Urinary incontinence.
3. Sexual dysfunction
Although the penis can be erect, but it is bent to the back side, and there may be erectile pain, most of which cannot be sexual intercourse.
4. Pubic symphysis separation
The normal pubic symphysis is about 5 mm wide on the X-ray photograph, which is a cartilage connection. The complete urethral fissure pubic symphysis is separated and widened. Only some fibrous tissues are connected between the left and right pubic bones, and the distance between the ischial nodules is also widened. .
5. Female urethra
It is characterized by splitting of the clitoris, separation of the labia, separation of the pubic symphysis and urinary incontinence. In addition, the patient has more urinary tract infections.
Clinical classification: In males, the urethra is located on the dorsal side of the penis. According to the position of the external urethra, it is divided into the following three types: 1 penis head type: the urethral opening is open to the wide and flat penis head; 2 penis type The urethral opening is between the pubic symphysis and the coronary sulcus. The urethral opening is broad and sinuous. The distal end of the urethra is grooved to the penis head. 3 The penis is pubic: the urethral opening is at the pubic symphysis, and the dorsal side of the penis There is a complete urethral groove to the penis head.
Examine
Examination of urethral fissure
First, no special inspection is required, and the naked eye can diagnose.
1. Pelvic X-ray films can determine the presence or absence of pubic symphysis separation. An intravenous urography can determine the function and morphology of the urinary tract and the presence or absence of other urinary tract malformations.
2. Cystoscopy is very helpful in determining urinary incontinence. The urinary incontinence has the phenomenon that the posterior urethra is wide and the bladder neck cannot be closed.
Second, angiography.
1, urography: Excretory urography (Excretory urography) also known as intravenous pyelography.
2. Retroperitoneal angiography.
3, abdominal aorta and renal angiography.
The ureteral ectopic occurs mostly in repetitive renal and ureteral malformations, and most ureteral ectopics are from the upper kidney segment of the repetitive kidney.
Diagnosis
Diagnosis and differentiation of upper urethra
Diagnosis can be confirmed by visual inspection alone. For urinary incontinence, attention should be paid to the examination of bladder neck muscle and urethral sphincter function.
Female urine leakage: ureteral ectopic opening, vesico-vaginal fistula, ureterovaginal fistula and other diseases due to urinary leakage symptoms, need to be differentiated from female urethral rupture with urinary incontinence, generally by asking about medical history, detailed physical examination, looking for specific parts of leakage The two are not difficult to identify. Congenital urinary malformations are most common in the kidney and ureteral malformations. Common symptoms are hematuria, abnormal urination, abdominal pain, and abdominal mass. Complications and comorbidities are most common with urinary tract infections.
