Epispadias is an extremely rare congenital condition in which the anterior wall of the urethra does not close partially or completely. The rarity of the pathology, occurring on average in one of 55,000 to 70,000 newborns, and its insufficient study lead to the fact that the exact causes of its occurrence are not understood. Treatment of epispadias in Israel is developed and performed by highly qualified urologists who enjoy a well-deserved reputation in international medical circles. Successful completion of plastic surgeries eliminates painful symptoms and ensures recovery for more than 90% of patients.
Typically, the condition is diagnosed in infants; however, surgical treatment is not indicated until the patient reaches three years of age. When choosing the method of surgery, the characteristics of the pathological changes in the urethra, clinical signs of the disease, and several other factors are taken into account. According to a multidisciplinary approach to the treatment process, in addition to urologists, pediatricians, surgeons, and child psychologists also work with patients. Feedback from the parents of young patients confirms the effectiveness and reasonable cost of therapy, the attention and friendliness of the medical staff, and the creation of the most comfortable conditions for the child in the clinics.
Treatment Methods for the Condition
Due to characteristic differences in anatomical structure, epispadias in males and females differs somewhat. At the same time, a rather complex classification of this condition has been established. Thus, two main forms of epispadias are distinguished: in the first, only the urethra is split, while in the second case, the wall of the urethra does not close in combination with a split of the bladder sphincter. These features significantly influence which treatment methods are included in the therapy scheme.
In cases where clitoral epispadias in girls or glanular epispadias in boys do not lead to urinary incontinence, specific surgical treatment is not indicated. Specialists consider surgery necessary only if epispadias causes the development of a number of physiological disorders and cosmetic defects in the child, including incontinence, the occurrence of skin diseases such as dermatitis and rashes. With prolonged progression of these pathologies, children develop psychological complexes and psycho-emotional disorders due to difficulties in establishing contact and communication with other children, problems with socialization, and being in a child group. Such negative influence on the developing psyche of the child is highly likely to lead to developmental delays.
Today, in Israeli clinics, surgical therapy, which was previously performed in two to three stages, is carried out in one surgical procedure. Special attention is given to male patients, as in these cases the surgery is complex and its successful completion requires the urologist-surgeon to have the highest level of qualification and extensive experience. The following goals are pursued during the operation:
- reconstruction of the missing fragment of the urethral wall;
- reconstructive plastic surgery of the anterior wall of the bladder (indicated in cases of total epispadias);
- restoration of the normal shape of the curved penis;
- giving the external reproductive organs a normal appearance.
During the preparation stage for the operation, the child is prescribed a treatment course to eliminate skin damage (rashes, dermatitis).
In cases of penile involvement in the stem form of the pathology, during the operation, the penis is straightened, after which plastic surgery of the urethra is performed. If the patient is diagnosed with the most complex, total form of epispadias, correction of the distorted shape of the penis is performed simultaneously with plastic surgery of the bladder neck and urethra, as well as correction of the abdominal musculature.
The anterior wall of the urethra is most often restored using tissue from the foreskin. To accurately determine the degree of curvature of the penis, saline is injected into the corpora cavernosa, resulting in an erection, which significantly facilitates the actions of the urologist-surgeon. Additionally, for approximately 10 days after the intervention, a plastic catheter must remain in the bladder.
Surgical treatment for girls is indicated in cases of persistent urinary leakage, rashes, dermatitis, and other skin irritations, as well as infectious inflammations of the urogenital organs. The operation aims at clitoral plastic surgery, and if necessary, reconstruction of the bladder neck.
For patients diagnosed with glanular epispadias who do not experience significant discomfort, surgical intervention is performed only after maturation. In this case, the main reason for seeking medical help is often the deformation of the glans penis and the inability to urinate without splashing.
Emptying and regular rinsing of the bladder using a catheter is necessary to prevent complications and ensure faster recovery after surgery. The most common complications include fistulas of the bladder and urethra, urinary incontinence, persistent narrowing of the urethra or vaginal lumen. In adult male patients, some curvature of the penis may persist, and erectile dysfunction and infertility may develop in some cases.
Through the successful treatment by Israeli specialists at the early stage of the disease, a favorable prognosis is usually achieved, normalizing the function of the urinary system and making the urination process fully controllable. It should be remembered that congenital pathologies of the urogenital system significantly affect the sexual activity and fertility of the patient upon reaching adulthood. After completing the treatment process, the child must regularly undergo check-ups with a urologist and complete the examinations prescribed for all subsequent years.
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Methods of Diagnosing the Pathology
Severe forms of the condition are detected during the examination of the newborn, while milder forms, especially in girls, are identified later when consulting a pediatrician with complaints of urinary incontinence. In medical centers in Israel, the examination of the child by a urologist, gynecologist, and surgeon, the performance of prescribed laboratory and instrumental studies, diagnosis, and development of a treatment plan are conducted in about three days.
After admission to the clinic, the patient is examined by the leading urologist. During the initial consultation, the doctor examines the child and clarifies the nature of the symptoms presented by the parents. The consultation concludes with the appointment of necessary examinations.
On the following day, the types of diagnostic procedures listed in the appointments are performed:
- laboratory blood tests;
- pyelogram;
- ultrasound of the urinary and reproductive systems;
- imaging studies (CT, MRI);
- urodynamic studies;
- electromyography of the bladder muscles.
The results of the studies are reviewed by a council consisting of a urologist and narrow-profile specialists. After studying the obtained data, the doctors collectively establish a diagnosis and develop a treatment program.
How Much Does Treatment of the Condition Cost
Among other questions, medical tourists are interested in the cost of therapy and its availability. Treatment in Israel allows the patient to save about 30% of the funds required in Western European countries and up to 50% of the amount needed in the USA.
Advantages of Treatment in Israel
- Pediatric urologists with a high level of qualification and many years of experience.
- Modern medical equipment.
- Use of modern technologies for performing plastic surgeries.
- Comfortable conditions.
- Affordable prices.
Successful treatment of epispadias will ensure your child’s health and high quality of life. Israeli clinics provide all the necessary conditions for highly effective therapy and rapid recovery.