Understanding Hypospadias and Epispadias: Diagnosis and Care
School
Northwestern State University of Louisiana**We aren't endorsed by this school
Course
FA 1040
Subject
Nursing
Date
Dec 12, 2024
Pages
2
Uploaded by CoachGrousePerson668
DIAGNOSISTypically made at birth during the first newborn assessment. CLINICAL THERAPYIf the provider is worrying about a chromosomal syndrome or genetic syndrome, we might see them order a chromosomal analysis. We might also geta pelvic ultrasound just to make sure thatall the internal structures are where they should be and how they should be.Depending on the size of the infant’s penis we might have to do some pre-op testosterone to augment penile growth. This would be a very specialized thing.MEDICATIONSNerve blocks, especially post-operatively to offer/get some really good pain controlon board for them.Anticholinergic medications for bladder spasms (oxybutynin or Ditropan) can alsohelp with the pain.Antibiotics IV post-operatively.PATHOPHYSIOLOGYThe cause is unknown. Likely very genetic in nature. Could also be environmental factors that play a partas well. Family history we want to ask about because there could be a genetic link. Any estrogen drugs used during pregnancy there is a potential link there. So, we’d want to ask mom if she took any pharmacologic drugs while she was pregnant. Advanced maternal age (mom >35 years old). Gestational diabetes. Preemies as well.SIGNS ANDSYMPTOMSMight see the baby has an abnormally small penis or micropenis, this is typically seen more with babies that have very extensive congenital anomalies or congenital syndromes that they’re suffering from or preemies as well. The foreskin may be abnormal, there might be extra foreskin or notquite enough. Also, might see a possible chordee (a ventral curvature/abnormal curvature of the penis). We also need to assess and make sure that the testicles aredescended because there’s an increased incidence of undescended testes with this condition.ETIOLOGYA congenital anomaly involving abnormal placement of the urethral meatus (urethral opening). Instead of the urethra terminating at the very tip of the penis it terminates somewhere else along either the bottom side (Hypospadias) or the top side (Epispadias).
SURGICALTREATMENTThe surgical correction is usually done between 6 and 12 months of age. Most babies are quite not big enough to withstand a full-blown surgery from birth, but we also haveto wait and make sure that the penis is big enough, so we don’t alter the anatomy and the function of the penis itself. Depending on thesize of the infant’s penis we might have to do some pre-op testosterone to augment penile growth. This would be a very specialized thing. We cannot circumcise this baby until we have corrected either the hypospadias or epispadias. Just because they might need that foreskin to use during the surgical NURSING MANAGEMENTAddress parental concerns and educate them. Protect the surgical site, so we might see the use of “no no’s” or bilateral wrist restraints just depending on how wildthe baby is. Do wound care as ordered. Monitor for signs and symptoms of infection, inflammation, and DEFINITELY bleeding. Monitor fluid intake and output (for perfusion and patency to make sure that the urethra does drain urine the way that it should). Monitor and report no urineoutput for an hour (ex: if we’ve started making urine and then it stops, you definitely want to report this because therecould be a kink, or something could be wrong internally and we need the surgeon to come and assess the child). Pain control would be huge both pharmacologic and non-pharmacologic. Antibiotics will likely be given IV post-operatively. EDUCATE is going to be huge, especially discharge teaching for this baby. No baths until the stent or catheter is removed, no pressure on the surgical site (don’t want the child tosit and straddle anything, no holding on hip, no straddle toys, rocking chairs, bikes,etc.) Report any leaking urine from the siteand any frank blood.POST-OPERATIVETREATMENTPost-operatively this child is going to come back with a stent or kind oflike a catheter placed to maintain patency in the urethra for about 5-10 days. We are going to double diaper (first diaper collects stool and has a hole to place the catheterthrough and maybe even a hole big enough to fit the penis through the front portion of the first diaper, so that way we keep any stool off of the surgical incision to prevent infection/irritation) this way we can easily see that we have urine draining, things are working the waythat they should or if something is wrong.