| Epispadias | |
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| Specialty | Medical genetics  |
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An epispadias is a rare type of malformation in which the urethra ends, in males, in an opening on the upper aspect of the penis, [1] and in females when the urethra develops too far anteriorly. It occurs in around 1 in 120,000 male and 1 in 500,000 female births.[ citation needed ]
Most cases involve a small and bifid penis, which requires surgical closure soon after birth, often including a reconstruction of the urethra. Where it is part of a larger exstrophy, not only the urethra but also the bladder (bladder exstrophy) or the entire perineum (cloacal exstrophy) are open and exposed on birth, requiring closure. Many parts of this article are incorrect. [ citation needed ]
Despite the similarity of name, an epispadias is not a type of hypospadias, and involves a problem with a different set of embryologic processes.[ citation needed ]
Women can also have this type of congenital malformation. Epispadias of the female may occur when the urethra develops too far anteriorly, exiting in the clitoris or even more forward. For females, this may not cause difficulty in urination but may cause problems with sexual satisfaction. Frequently, the clitoris is bifurcated at the site of urethral exit, and therefore clitoral sensation is less intense during sexual intercourse due to frequent stimulation during urination. However, with proper stimulation, using either manual or positional techniques, clitoral orgasm is definitely possible.[ citation needed ]
Epispadias is an uncommon and partial form of a spectrum of failures of abdominal and pelvic fusion in the first months of embryogenesis known as the exstrophy - epispadias complex. While epispadias is inherent in all cases of exstrophy it can also, much less frequently, appear in isolation as the least severe form of the complex spectrum. It occurs as a result of defective migration of the genital tubercle primordii to the cloacal membrane, and so malformation of the genital tubercle, at about the 5th week of gestation.[ citation needed ]
The main treatment for isolated epispadias is a comprehensive surgical repair of the genito-urinary area usually during the first 7 years of life, including reconstruction of the urethra, closure of the penile shaft and mobilisation of the corpora. The most popular and successful technique is known as the modified Cantwell-Ransley approach. In recent decades however increasing success has been achieved with the complete penile disassembly technique despite its association with greater and more serious risk of damage.[ citation needed ]
Even with successful surgery, patients may have long-term problems with: [ citation needed ]
The clitoris is a female sex organ present in mammals, ostriches and a limited number of other animals. In humans, the visible portion – the glans – is at the front junction of the labia minora, above the opening of the urethra. Unlike the penis, the male homologue (equivalent) to the clitoris, it usually does not contain the distal portion of the urethra and is therefore not used for urination. The clitoris also usually lacks a reproductive function. While few animals urinate through the clitoris or use it reproductively, the spotted hyena, which has an especially large clitoris, urinates, mates, and gives birth via the organ. Some other mammals, such as lemurs and spider monkeys, also have a large clitoris.
The urethra is a tube that connects the urinary bladder to the urinary meatus for the removal of urine from the body of both females and males. In human females and other primates, the urethra connects to the urinary meatus above the vagina, whereas in marsupials, the female's urethra empties into the urogenital sinus.
In female human anatomy, the clitoral hood is a fold of skin that surrounds and protects the glans of the clitoris; it also covers the external shaft of the clitoris, develops as part of the labia minora and is homologous with the foreskin in male genitals. The clitoral hood is composed of muccocutaneous tissues; these tissues are between the mucosa and the skin, and they may have immunological importance because they may be a point of entry of mucosal vaccines. The clitoral hood is also important not only in protection of the clitoral glans, but also in pleasure, as it is an erogenous tissue.
The glans is a vascular structure located at the tip of the penis in male mammals or a homologous genital structure of the clitoris in female mammals.
Hypospadias is a common variation in fetal development of the penis in which the urethra does not open from its usual location in the head of the penis. It is the second-most common birth abnormality of the male reproductive system, affecting about one of every 250 males at birth. Roughly 90% of cases are the less serious distal hypospadias, in which the urethral opening is on or near the head of the penis (glans). The remainder have proximal hypospadias, in which the meatus is all the way back on the shaft of the penis, near or within the scrotum. Shiny tissue that should have made the urethra extends from the meatus to the tip of the glans; this tissue is called the urethral plate.
Phalloplasty is the construction or reconstruction of a penis, or the artificial modification of the penis by surgery. The term phalloplasty is also occasionally used to refer to penis enlargement.
Metoidioplasty, metaoidioplasty, or metaidoioplasty is a female-to-male sex reassignment surgery.
Sex reassignment surgery for female-to-male transgender people includes a variety of surgical procedures that alter anatomical traits to provide physical traits more comfortable to the trans man's male identity and functioning. Non-binary people assigned female at birth may also have these surgeries.
Vaginoplasty is any surgical procedure that results in the construction or reconstruction of the vagina. It is a type of genitoplasty. Pelvic organ prolapse is often treated with one or more surgeries to repair the vagina. Sometimes a vaginoplasty is needed following the treatment or removal of malignant growths or abscesses in order to restore a normal vaginal structure and function. Surgery to the vagina is done to correct congenital defects to the vagina, urethra and rectum. It will correct protrusion of the urinary bladder into the vagina (cystocele) and protrusion of the rectum (rectocele) into the vagina. Often, a vaginoplasty is performed to repair the vagina and its attached structures due to trauma or injury. Labiaplasty, which alters the appearance of the vulva, can be performed as a discrete surgery, or as a subordinate procedure within a vaginoplasty.
Pediatric urology is a surgical subspecialty of medicine dealing with the disorders of children's genitourinary systems. Pediatric urologists provide care for both boys and girls ranging from birth to early adult age. The most common problems are those involving disorders of urination, reproductive organs and testes.
Intersex medical interventions, also known as intersex genital mutilations (IGM) are surgical, hormonal and other medical interventions performed to modify atypical or ambiguous genitalia and other sex characteristics, primarily for the purposes of making a person's appearance more typical and to reduce the likelihood of future problems. The history of intersex surgery has been characterized by controversy due to reports that surgery can compromise sexual function and sensation, and create lifelong health issues. Timing, evidence, necessity and indications for surgeries in infancy, adolescence or adult age have been controversial, associated with issues of consent.
Penile agenesis is a birth anomaly in humans, occurring about once in 5–6 million male births, in which a male child is born without a penis. A partner condition is testicular agenesis or gonadal agenesis. This is when a male child is born without gonads and consequently develops no testes. Penile agenesis occurs often as a consequence of testicular agenesis, but the reverse is never the case. Most patients in both cases have no known family history and usually have an otherwise normal male anatomy.
Bladder exstrophy is a congenital anomaly that exists along the spectrum of the exstrophy-epispadias complex, and most notably involves protrusion of the urinary bladder through a defect in the abdominal wall. Its presentation is variable, often including abnormalities of the bony pelvis, pelvic floor, and genitalia. The underlying embryologic mechanism leading to bladder exstrophy is unknown, though it is thought to be in part due to failed reinforcement of the cloacal membrane by underlying mesoderm. Exstrophy means the inversion of a hollow organ.
Radical retropubic prostatectomy is a surgical procedure in which the prostate gland is removed through an incision in the abdomen. It is most often used to treat individuals who have early prostate cancer. Radical retropubic prostatectomy can be performed under general, spinal, or epidural anesthesia and requires blood transfusion less than one-fifth of the time. Radical retropubic prostatectomy is associated with complications such as urinary incontinence and impotence, but these outcomes are related to a combination of individual patient anatomy, surgical technique, and the experience and skill of the surgeon.
The urinary meatus, also known as the external urethral orifice, is the opening of the urethra. It is the point where urine exits the urethra in males and in females and where semen exits the urethra in males. The meatus has varying degrees of sensitivity to touch. The meatus is located on the glans of the penis or in the vulval vestibule.
The development of the reproductive system is a part of prenatal development, and concerns the sex organs. It is a part of the stages of sexual differentiation. Because its location, to a large extent, overlaps the urinary system, the development of them can also be described together as the development of the urinary and reproductive organs.
Diphallia, penile duplication (PD), diphallic terata, or diphallasparatus, is an extremely rare developmental abnormality in which a person is born with two penises. The first reported case was by Johannes Jacob Wecker in 1609. Its occurrence is 1 in 5.5 million boys in the United States.
Clitoroplasty is the surgical creation of a clitoris in transgender women, restoration in the case of procedures reversing the damage caused by female genital cutting, or surgery to change clitoral size for women and girls with congenital adrenal hyperplasia.
The mechanics of human sexuality or mechanics of sex, or more formally the biomechanics of human sexuality, is the study of the mechanics related to human sexual activity. Examples of topics include the biomechanical study of the strength of vaginal tissues and the biomechanics of male erectile function. The mechanics of sex under limit circumstances, such as sexual activity at zero-gravity in outer space, are also being studied.
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