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Paediatric Surgery
Male Epispadias Genitourinary Implications
Built from Puri — Pediatric Surgery and Pediatric Urology
What’s inside
10 sections · 61 slides
Overview
- What this deck will teach you
Foundations
What epispadias is and where it sits
- First principles: what is epispadias?
- Where it belongs: the exstrophy-epispadias complex
- Epispadias in numbers
- Why this is a hard problem to fix
A Short History
From skin strips to complete penile disassembly
- The earliest descriptions
- Learning that the bladder neck matters too
- Converting epispadias into a hypospadias
- Free grafts and the short-corpora problem
- Modern refinements and the disassembly era
- Milestones in epispadias repair
Embryology and Genetics
Why the defect forms
- The cloacal membrane theory (Muecke)
- Why the opening ends up on top (Patten and Barry)
- The genetic contribution
Anatomic Classification
Grading by where the urethra opens
- The anatomy of the defect
- Grade 1: glanular epispadias (mildest, rarest)
- Grade 2: penile epispadias
- Grade 3: penopubic epispadias (most severe)
- The three grades of male epispadias
- Grades side by side
Associated Anomalies
The hidden problems beyond the penis
- Four extragenital problems to hunt for
- The bladder neck: the key to continence
- Bladder capacity and urodynamics
- Pubic diastasis: the bony gap
- Vesicoureteral reflux: present but often benign
- Extragenital findings in penopubic epispadias
- Putting the work-up together
Surgical Management
Timing and the shared operative steps
- When to operate
- Steps common to every epispadias repair
- Key components of the surgical repair
- Repairing glanular epispadias
- Repairing penile epispadias
- Repairing penopubic epispadias
Cosmetic Reconstruction
Making the penis look, as well as work, normal
- Why appearance is its own challenge
- Glansplasty: rebuilding the head
- Skin coverage: solving the shortage
- Refinements to reduce scarring and tethering
- Salvage after a failed repair
Continence and Bladder Neck
Keeping urine in
- The continence problem
- Does urethroplasty alone help continence?
- When the bladder neck approach falls short
Outcomes and Complications
What the long-term data show
- The complications that recur
- Selected epispadias repair series
- Reading the series with caution
- Long-term outcomes (Thomas et al. 2020)
- Three things to remember
- References (1/4)
- References (2/4)
- References (3/4)
- References (4/4)
- Pediatric Surgery and Pediatric Urology