10.03 Epispadias and Hypospadias

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Hey guys in this lesson we are going to be talking about epispadias and hypospadias.

Both epispadias and hypospadias are congenital anomalies in which the male urethra is abnormally placed. Epispadias is when the urethral opening is on the top of the penis. Hypospadias is when the urethral opening is on the underneath side of the penis. One one of the biggest problems with hypospadias is it can cause something called chordee (corday). This is when the penis curves downward to varying degrees. Usually the further the urethra is from the tip of the penis, like in the third photo here, the wrose the chordee is, and more difficult the surgical correction is.

Every newborn will undergo a thorough assessment looking for any signs of congenital anomalies. We have a checklist for you that goes through what is included in the newborn checklist. For male newborns, it’s important to assess the urethra and it’s placement, by pulling for foreskin back.

Other anomalies that are associated with epispadias and hypospadias are cryptorchidism, which is failure of one or both of the testes to descend, and inguinal hernias. So make sure to look for these as well.

These patients need reconstructive surgery. These babies should not be circumcised at birth because the foreskin can be used in the reconstructive process. 6-12 months is the preferred age to perform the surgery. Two major goals of this surgery are to preserve sexual function and improve the appearance of the penis to help the child when he begins to develop a body image.

Post-op for these procedures is no walk in the park. A stent will probably be left in place for 5-10 days as the urethra heals. And pain management is super important because bladder spasms are pretty common. These are extremely painful and may cause the child to cry and even pull knees to chest. To help with these spasms oxybutynin is given. Constipation is an unfortunate side effect of oxybutynin so we’ve got to make sure to treat that as well.

When these patients are ready to go home, parents need to be informed on how to manage the stent and provide wound care. The child should not be given a tub bath until the surgeon has cleared them to. And parents can be advised to place a small about of ky jelly in the diaper to help keep the wound and penis from sticking and causing pain with each diaper change.

You’re priority nursing concepts for are elimination, human development and pain control

Okay, let’s review your key points for this topic! Epispadias is the urethral opening on the top of the penis. Hypospadias is when the urethra opens on the underside of the penis.

These congenital anomalies both will require surgical reconstruction. Usually this is done around 6-12 months.

Post-op care is focused on stent management and administering oxybutynin to help stop bladder spasms which are very painful.

Parent education is super important as kids may be going home with a stent in place and parents need to know how to manage that as well as provide wound care.

That's it for our lesson on epispadias and hypospadias. Make sure you check out the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!
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