Congenital epispadias is often complicated by bladder exstrophy and can be considered part of the embryology of bladder exstrophy.

bubble_chart Epidemiology

Incidence: The incidence of epispadias is 1 in 120,000 males and 1 in 4,500,000 females.

bubble_chart Clinical Manifestations

Clinical manifestations: Urinary incontinence rarely occurs in the glanular type, while the incidence rates of urinary incontinence in the penile and penopubic types are 75% and 95%, respectively.

In females, epispadias presents with clitoral splitting and separated labia, with most cases experiencing urinary incontinence.

Urinary incontinence is typically due to underdeveloped urethral sphincters, and distal penile curvature may also occur. Pubic symphysis diastasis is often associated with bladder exstrophy, and epispadias is considered a milder form of bladder exstrophy; severe epispadias is frequently complicated by bladder exstrophy.

Clinical classification: In males, the urethra is located on the dorsal side of the penis and is divided into the following three types based on the position of the external urethral orifice: ① Glanular type: The external urethral orifice opens on the broad and flat dorsal side of the glans penis; ② Penile type: The external urethral orifice opens between the pubic symphysis and the coronal sulcus, appearing wide and trumpet-shaped, with a groove extending distally from the orifice to the glans penis; ③ Penopubic type: The urethral orifice opens at the pubic symphysis, with a complete urethral groove on the dorsal side of the penis extending to the glans.

bubble_chart Treatment Measures

Control urination, excise fibrous bands to straighten the penis, and reconstruct the urethra. Currently, the success rate of repairing the urethral sphincter is not high. However, Tanagho and Smith (1972) reported that complete urinary control could be achieved by implanting a tube rolled from the anterior bladder wall flap between the bladder and prostatic urethra. Kramer and Kelali (1982) reported that satisfactory cosmetic results were obtained through urethroplasty involving the excision of fibrous bands and advancement of the urethral meatus. If urinary incontinence persists after surgical correction, an artificial sphincter procedure may be considered.