Indian Journal of Urology
CASE REPORT
Year : 2000  |  Volume : 16  |  Issue : 2  |  Page : 163--164

Female epispadias

Dharm Raj Singh, SN Sagade 
 Department of Urology, PD. Hinduja National Hospital and Medical Research Centre, Mumbai, India

Correspondence Address:
S N Sagade
Department of Urology, P.D. Hinduja National Hospital and Medical Research Centre, V.S. Marg, Mahim, Mumbai - 400 016
India




How to cite this article:
Singh DR, Sagade S N. Female epispadias.Indian J Urol 2000;16:163-164


How to cite this URL:
Singh DR, Sagade S N. Female epispadias. Indian J Urol [serial online] 2000 [cited 2023 Mar 30 ];16:163-164
Available from: https://www.indianjurol.com/text.asp?2000/16/2/163/22223


Full Text

 Case Report



A 6-year-old female child presented with leakage of urine per urethra since birth. There were no other urological complaints. External genitalia on examination revealed bi­fid clitoris and labia minora. There was complete dorsal split in the urethra not involving the sphincter [Figure 1]. Vagina and hymen were normal. On investigation, hemogram and urine routine were normal. Intravenous urography was normal. Voiding cystourethrogram (VCUG) showed no reflux. Patient was subjected to surgery. Duplay's urethral repair along with reconstruction of the labia minora and clitoris was done. An inverted U-shaped incision was made on both sides of the urethral plate en­circling the fneatus. Both the cut edges of the flaps were sutured in 3 layers by vicryl 4/0 over a Fr. 10 Foley's cath­eter [Figure 2]. Urethral catheter was removed after 8 days. There was satisfactory cosmetic result postoperatively. Her urinary incontinence which persisted after surgery was managed conservatively (by amitryptilline) with signifi­cant improvement after two years.

 Comments



Female epispadias is a rare congenital anomaly with an incidence of 1/480,000 female births. [1] Davis [2] has di­vided the female epispadias into 3 degrees: 1) Patulous urethra; 2) Urethra dorsally split and; 3) Cleft involving the whole urethra and bladder neck, causing complete uri­nary incontinence. Milder forms of epispadias are ex­tremely rare. [3] This may be because that they go unnoticed due to absence of incontinence in these children. Genital defects include bifid clitoris and poorly developed labia minora which end anteriorly at the corresponding half of bifid clitoris. [4] The mons is depressed while symphysis pubis is usually closed but may be represented by a nar­row fibrous band. The vagina and internal genitalia are usually normal. 30 to 75% of the epispadias are associ­ated with reflux. [5]

Present report is presented because it was a rare case of second degree epispadias having dorsal splitting of ure­thra with incontinence. Although her presenting complaint was urinary incontinence on cystourethroscopy the blad­der neck and external sphincter were normal. Repair of urethra, clitoris and labia minora gave her good and ac­ceptable appearance of external genitalia.

References

1Dees JE. Congenital epispadias with incontinence. J Urol 1949: 62:513.
2Davis DM. Epispadias in females and its surgical treatment. Surg Gynec Obstet 1928; 47:680.
3Mollard P, Basset T, Mure PY. Female epispadias. J Urol 1997; 158:1543-1546.
4Gearhart JP, Peppas DS, Jeffs RD. Complete genitourinary recon­ struction in female epispadias. J Urol 1993; 149: 1110-1113.
5Gearhart JP. Jeffs RD. Exstrophy of the bladder, epispadias and other bladder anomalies. In: Campbell's Urology, 7th ed. Walsh PC, Retik AB, Vaughan Jr. ED, Wein AJ. (ed.). Saunders, 1998: 2:1979-1998.