Congenital Female Epispadias with Incontinence

Hendren, W. Hardy

doi:10.1016/s0022-5347(17)55105-8

Cited by 38 publications

(14 citation statements)

References 17 publications

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“…This procedure, in combination with contouring of the mons pubis with puboplasty, resulted in the illusion of caudal recession of the vaginal introitus. Satisfactory cosmesis employing this surgical technique has been described in several surgical series [18,[67][68][69][70][71].…”

Section: Discussionmentioning

confidence: 98%

Aesthetic aspects of abdominal wall and external genital reconstructive surgery in bladder exstrophy-epispadias complex

VanderBrink¹,

Stock²,

Hanna

2006

Curr Urol Rep

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Long-term follow-up of patients born with classical bladder exstrophy-epispadias complex (EEC) reveals that many of them suffer from poor self-image, and the aesthetic aspects of the genitalia and lower abdomen acquire greater significance with age. In this article, we review the aesthetic outcomes in performing puboplasty, umbilicoplasty, and genitoplasty in patients born with EEC. Retrospective review of the cosmetic and functional outcomes in 116 patients born with EEC treated by puboplasty, umbilicoplasty, or genitoplasty was performed. Satisfaction with the cosmetic and functional outcomes of these three reconstructive surgeries was high following initial reconstructive efforts (> 90%). Attention to cosmesis during abdominal wall and genital reconstruction for EEC helps to improve a patient's perception of body image and self-esteem. Our experience with these procedures over the past 25 years demonstrated that the efforts directed toward aesthetics have been well worthwhile.

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Section: Discussionmentioning

confidence: 98%

Aesthetic aspects of abdominal wall and external genital reconstructive surgery in bladder exstrophy-epispadias complex

VanderBrink¹,

Stock²,

Hanna

2006

Curr Urol Rep

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“…Female epispadias has been described as a very rare condition, being 3-4 times less common than in males [2,[6][7][8]. It has also been suggested that mild degrees of epispadias are much rarer than more obvious forms, although there is no adequate explanation for this [7].…”

Section: Discussionmentioning

confidence: 99%

“…On inspection the bladder lining was visible through a patulous urethra, and direct pressure over the bladder caused a continuous stream of urine. Both ureters were re-implanted with an antireflux procedure and the urethral sphincter reconstructed, all uneventfully [2,5,6]. There was an improvement in continence but by 7 years old complete continence had not been achieved, and the dribbling had worsened.…”

Section: Casementioning

confidence: 99%

Female epispadias: are we missing the diagnosis?

et al. 2004

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OBJECTIVETo describe three of four female patients with occult epispadias, as usually epispadias is reported to be a rare condition in females (1/480 000), and obvious and easy to diagnose, but less severe variants may still involve urethral sphincter incompetence in the absence of obvious clinical signs.PATIENTS AND METHODSThe hospital records over a 10‐year period (1 January 1991 to 31 December 2000) were reviewed to find all female patients diagnosed with epispadias. Data were collected from the Consultative Council on Obstetric and Paediatric Mortality and Morbidity for the number of live births per year for the decade studied, and the incidence of female epispadias determined.RESULTSOver the 10‐year period there were 13 patients with a diagnosis of epispadias, from 636 698 total live births; four were female and nine male. Each of the female patients had varying degrees of epispadias; three had subtle signs with apparently normal external genitalia, and only one had a bifid clitoris. However, even the most minor variant case had a palpable notch in the symphysis pubis, and an ‘oblong’ external urethral meatus. Thus the incidence of female epispadias is at least 1/160 000.CONCLUSIONEpispadias in females may be up to three times more common than previously expected, but even experienced clinicians can miss the diagnosis. The importance of a careful examination should be emphasized, especially in female patients with chronic wetting of unknown cause. A bifid clitoris is an important sign but not always present. Key diagnostic features include drug‐resistant wetting, a very low leak pressure on cystometrography, a palpable gap in the pubic symphysis and an abnormal oval‐shaped external urethral meatus.

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“…In three of the largest reported series, of a total of 26 cases there was not a single case presenting in adulthood, i.e. beyond puberty [1,3,4]. In developing countries such as India, where illiteracy and poverty are common and women have a low status in society, patients tend to hide their problem and suffer in silence, hence their late presentation.…”

Section: Discussionmentioning

confidence: 99%