HIPOSPADIA

DAN
EPISPADIA

RIZKA DWI AULIA

D3
Dokter mampu membuat diagnosis klinik terhadap penyakit tersebut
dan menentukan rujukan yang paling tepat bagi penanganan pasien
selanjutnya. Dokter juga mampu menindaklanjuti sesudah kembali
dari rujukan.
HIPOSPADIA
Definisi
• Hipospadia adalah kelainan akibat perkembangan penis yang tidak
tuntas atau tertahan (Kongenital)
• Hipospadia bisa dikarakteristikan dengan adanya bukaan meatus
uretra yang terletak di proksimal, adanya kulit tipis yang menutupi
bagian dorsal, bentuk penis yang melengkung.
Etiologi Epidemiologi
• Hipospadia terjadi karena • The incidence of hypospadias is
adanya gangguan stimulasi 1 in 250 live births. Hypospadias
pertumbuhan pada usia 9 is noted to also occur in 6–8% of
sampai 12 bulan gestasi. affected individuals’ fathers and
14% of male siblings.
Klasifikasi Hipospadia
Gejala Klinis
• Hypospadias can cause difficulty with both sexual intercourse and
urinating from a standing position
Tata Laksana
• Rujuk : dokter spesialis urologi pediatrik
• Pilihan Tata Laksana yang mungkin akan diberikan kepada pasien:

1. Treatment The need for further urinary tract evaluation is

unnecessary in those diagnosed with isolated
hypospadias.
2. Any child with suspected hypospadias should not be
circumcised; the foreskin can be used for surgical repair should
it be necessary.
3. If surgical repair is elected,
- Timing of surgery should be between 6 and 18 months of age.
- Preoperative hormones in the form of β -hCG, testosterone, or
DHT have been administered to increase penile size and vascularity.
- Surgery should be individualized to the patient.
- Correction may require more than one operation (i.e., staged
approach). General principles of surgical repair include orthoplasty,
urethroplasty, glansplasty, and skin closure.
• Curvature less than 30° is most often corrected by midline dorsal
placation (Nesbit repair).
• Curvature exceeding 30° may require ventral lengthening by
corporotomy with dermal grafting.
• Most urethroplasties are accomplished by tubularization
of the urethral plate, often with a dorsal midline relaxing
incision to widen the plate.
• Tissue fl aps and grafts can be utilized, if necessary.
 Complications may include bleeding, infection,
fistula, meatal stenosis, urethral stricture,
diverticulum, and dehiscence. Most
complications require a second surgery for a
successful outcome. In these cases, surgery
should be delayed for at least 6 months to allow
tissues to heal from prior surgeries
EPISPADIA
Definisi
• Epispadias can range from dorsal malpositioning of the urethra
on the glans with an intact sphincter to a penopubic defect
with a splayed sphincter and incontinence
• Patients with distal glans epispadias may have an abnormal
bladder neck and posterior urethra with incontinence despite a
seemingly complete urethra
• The penile deformity includes dorsal chordee and penile
shortening
Epidemiologi
• Epispadias occurs at an incidence of 1:117,000; 70% of cases are
complete epispadias with incontinence
Management
• Rujuk : dokter spesialis urologi pediatrik
• Pilihan tata laksana

1. Continence with preservation of upper tracts and functional and

cosmetic penile reconstruction are the reconstructive goals
2. The staged approach includes early urethroplasty, followed by
BNR for continence
3. One reconstructive option is the modified Cantwell– Ransley
epispadias repair.

The urethral plate is dissected off of the corpora proximally but remains
in continuity with the distal glans. The urethra is tubularized, and the
corporal bodies are rotated medially over the urethra
• In complete penile disassembly, another option, the urethral plate is
completely separated from each hemicorpus and hemiglans, and the
corporeal glanular bodies are separated from each other.
• The urethral plate is tubularized and brought ventral
to the corporal bodies

• Following penile straightening, if the meatus does not reach the

glans, it is matured to the ventral aspect of penis, creating a
hypospadiac meatus.
 Surgical complications include urethral fistula,
stenosis, residual penile curvature, and persistent
incontinence

• With epispadias, adequate bladder capacity is the major predictor of

voiding continence
• Urethroplasty before 12 months of age may enable higher bladder
capacities, while urethroplasty after 29 months of age may negatively
impact bladder growth
Outcomes
• Over 70% of patients achieve continence Penile reconstruction
enables most patients to achieve straight penis with normal erectile
function, with ~80% of those patients reporting satisfactory
intercourse
•Female epispadias is rare, with an incidence of
around 2:1,000,000
• The urethra may be patulous, split dorsally along most of the urethra,
or split along the entire urethra including a gap in the sphincter. There
is a bifi d clitoris, depressed mons with nonhair-bearing skin, and
diminutive labia minora with little to no clitoral hood
• Vesicoureteral reflux is common, as is a widened pubic
diastasis
• As in boys, goals of therapy include continence with preservation
of renal function, and functional and cosmetic external
genitalia
• In single-stage reconstruction, urethroplasty and bladder neck
plication (with or without cystoscopic guidance) are performed
simultaneously
• In staged reconstruction, urethroplasty and feminizing genitoplasty
are performed early to help increase bladder capacity for later BNR
and ureteral reimplantation. Continence rates >85% are reported.