Epispadias Surgery in India: Costs, Top Doctors & Leading Hospitals

Epispadias is a rare congenital condition that affects the urethra. Bladder exstrophy is another type of congenital abnormality that is often associated with it. Early detection followed by appropriate medical treatment can help manage the condition and avoid any long-term complications. Understanding the symptoms, diagnostic procedures, and available treatment options can help manage the condition.

Epispadias is a condition present at birth that affects the urethra, which is a tube that carries urine from the bladder to the outside of the body. In boys with epispadias, the urethra does not develop fully and opens on the upper surface of the penis instead of at the tip. The area between the urethral opening and the tip of the penis can appear split and resemble an open book. In girls with epispadias, the urethral opening is located closer to the clitoris or the lower abdomen, which can affect normal urinary and genital function.

Most boys and girls who are born with genitals that appear normal and function properly. However, in children born with epispadias, the urethra and external genitalia do not look or function normally. Epispadias is usually diagnosed at birth during a physical examination of the newborn. Imaging studies, such as an excretory urogram (an X-ray examination of the urinary tract) is used to confirm the diagnosis and assess the extent of the condition.

What are the Types of Epispadias That Affects Males?

Epispadias can be classified based on the meatus' exact location. The urinary meatus is the opening in the penis via which urine leaves the body. It is this location that affects how well the bladder can store urine. If the meatus is closer to the base of the penis, the condition is more likely. It affects the bladder sphincter and urine control. In males, the types of epispadias include:

1. Glanular Epispadias:

Glanular epispadias is the most familiar type of epispadias. The meatus is found on the head of the penis. Almost all boys have a good bladder neck with this type of epispadias. They can hold urine and even toilet training normally. This doesn't mean it is cured. The bend and the abnormal opening of the penis will still need to be fixed with surgery.

2. Penile Epispadias:

Penile epispadias is a condition where the meatus is found along the penis shaft in a boy.

3. Penopubic Epispadias:

In Penopubic epispadias, the meatus is located near the pubic bone. The pelvic bones do not come together. Also, the sphincter can not close completely.

How does Epispadias Affect Male and Female?

Epispadias affect males and females differently. Here's how:

■ For Males:

If the opening in the penis is closer to the base and abdominal wall, it affects the bladder sphincter. It fails to hold the urine. In cases with penupubic epispadias, the pelvic bones don't come together in the front. As the bladder sphincter has the shape of a horseshoe, it doesn't close fully. That is why the urine leaks out.

Males with penile and penupubic epispadias often leak urine with stress or strenuous work. A fixed bladder neck through surgery remains the only option for them. Males face fewer problems with glandular epispadias. They still have to fix the bend and abnormal opening through surgery.

■ For Females:

Epispadias is rare in females. Only 1 in 484,000 cases suffer from this condition.

■ Baby girls may have:

• The urethral opening toward the clitoris or even in the lower abdomen.
• Pubic bones are separated in different degrees. So, the clitoris can't connect in the middle. This results in 2 halves of the clitoris.
• Labia that don't form properly.
• Problems with the bladder neck, resulting in urine control issues.
• Girls with epispadias fail to control urine and often leak in stress, laughing, sneezing, coughing, and strenuous work.

What are the Symptoms of Epispadias?

Epispadias symptoms vary in males and females:

■ In Males:

• Rather than the tip, the urethral opening is on the upper portion of the penis.
• The penis may appear broad and short. The head of the penis may split.
• Due to the abnormal urethral opening, controlling urine can become challenging.
• Some males with epispadias may experience curvature or bending of the penis.
• Males often struggle to urinate due to ectopic urethral opening.
• They also might face urinary incontinence, which means loss of bladder control.

■ In Females:

• The urethra is not properly in its position here. It opens above the clitoris and vaginal opening.
• The clitoris usually gets divided into two parts.
• Epispadias can be involved with other abnormalities in the pelvic area.
• Females, with rare and fewer symptoms, are diagnosed later in life. It leads to frequent painful urination and recurrent UTIs.

Doctors usually detect it at the hospitals after birth. Diagnosis of epispadias takes place before anyone notices any symptoms. If the case is mild, it might go undetected. Parents might only be able to detect some urine leaking while they toilet-train their children. That is why it goes undetected in females most of the time.

What are the Causes of Epipadias?

The exact causes of epispadias are not fully understood. Some research works suggest it could be related to fetal exposure to low levels of androgens and estrogens.

Some causes of epispadias are -

1. Genetic Factors:

Epispadias could occur due to genetic factors as they can sometimes run in families. Genes in genital and urinary tract development may undergo mutations. It contributes to the condition.

2. Abnormal Foetal Development:

Epispadias may occur during fetal development. It happens when urethral and genital tissue development is improper.

3. Chromosomal Abnormalities:

Chromosomal abnormalities can be associated with epispadias in some rare cases.

4. Environmental Factors:

Some researchers have suggested the possibility. Certain environmental factors or toxins during pregnancy can heighten epispadias risk.

What are the Types of Epispadias Surgery in India for Boys?

There are a few epispadias surgery options that are typically done to treat epispadias in boys. They are:-

1. The Modified Cantwell-Ransley Technique:

This epispadias surgery rebuilds the penis. The surgeon might take from the partially reconstructed penis and move the urethra to a better location.

2. Mitchell Technique:

This technique completely reconstructs the penis. It ensures that the urethra is in the best position, and it corrects the chordee.

Surgeons modify these surgeries based on the type of epispadias patients have. This is to meet the individual needs of the patient. A child with an exstrophy-epispadias complex might need a more intricate surgery.

Surgery varies based on types, symptoms, and severity. However, the general steps of the procedure remain essentially the same. After administering general anesthesia, the surgery will commence. It involves disassembling the penis into three separate sections of tissue. The urethra is reconstructed using a procedure called urethroplasty.

What are the Types of Epispadias Surgery in India for Girls?

Girls usually go through less complex epispadias surgery than boys. The type of surgery may depend on how the doctor diagnoses epispadias. If epispadias diagnosis has been done at birth, urinary control will not be a problem. The doctors can -

• Connect the two parts of the clitoris.
• Correct the placement of the urethra.

If the problem isn't diagnosed or treated until later, girls may have to go through surgery in order to:

• Correct incontinence, i.e., the lack of urine control.
• Reconstruct a narrow vaginal opening.

Best Urology Surgeons for Epispadias Surgery in India

Epispadias is a rare congenital condition where the urethra opens on the upper aspect of the penis in males or near the clitoris in females, rather than at the normal location. Surgical correction can help, not only for cosmetic reasons but also to restore proper urinary function and improve quality of life. India is home to a number of highly skilled paediatric and adult urological surgeons for epispadias surgery who are experienced in managing rare and complex genitourinary anomalies, including epispadias and hypospadias. With access to advanced surgical techniques and high-quality medical infrastructure, India has become a primary location for patients needing cost-effective epispadias treatment.

1. Dr. Shafiq Ahmed

Dr. Shafiq Ahmed is a top epispadias treatment doctor in India, specialising in complex urethral reconstruction, pediatric urology, and congenital urogenital anomalies. He has extensive experience performing urological procedures, including epispadias repair surgeries, hypospadias repair, prostatectomy and more.

2. Dr. Ashok Kumar Gupta

Dr. Ashok Kumar Gupta is an experienced doctor for epispadias treatment in India, focusing on urethral reconstruction, bladder exstrophy, and congenital penile anomalies. His areas of specialisation include epispadias, transurethral resection of the prostate, enlarged prostate treatment, and more.

3. Dr. Anshuman Aggarwal

Dr. Anshuman Aggarwal is a leading epispadias treatment doctor in India, with expertise in performing complex congenital urological surgeries, hypospadias, and epispadias repair. He has to date, performed more than 10,000 successful urological procedures and his specialities include pediatric urological procedures for conditions including epispadias, hypospadias and undescended testicles.

4. Dr. Aman Gupta

Dr. Aman Gupta is an epispadias treatment specialist in India trained in performing urethral and penile reconstruction, congenital urinary anomalies, and pediatric urology. He provides comprehensive care for epispadias patients, including pre-surgical planning, corrective surgery, and post-operative follow-ups.

What is the Cost of Epispadias Surgery in India?

When considering surgery for epispadias, several cost factors come into play, one of them being cost. Cost of epispadias treatment in India can be affected by a lot of factors, including surgeon fees, hospital charges, anaesthesia, post‐operative care and follow‑up, and any otherprocedures (for instance, if bladder reconstruction is required). With CureIndia, patients are linked to accredited hospitals with experienced paediatric urologists for treatment, all at an affordable cost compared to countries like the US and the UK, where the same procedure can cost double with the bonus of large waiting times.

Below is a cost table showcasing the cost and stay details relating to epispadias treatment in India:

How is Recovery After Epispadias Surgery in India?

The recovery period depends on how complex the surgery or treatment is. Children who had a minor procedure will come back home in a day or two and will recover quickly. Epispadias repair may be one process of many that they need, for the children with bladder exstrophy. They might need to stay in the hospital for a longer period. Recovery will also take longer in these type of cases.

Epispadias Vs. Hypospadias

Both epispadias and hypospadias are congenital disabilities involving the urethra. Both describe the position of the urethral opening. But the two are different in many ways, like -

Epi- means above, hypo- means below & and spades in Greek means the opening of the urethra. In hypospadias, the opening is not at the tip or between the clitoris and the vaginal opening. Instead, it causes an abnormal ventral opening on the penis or near/within the vaginal orifice.

Hypospadias is more common. It is associated with other conditions such as chordee, inguinal hernias, and cryptorchidism. Epispadias is often associated with bladder exstrophy. This condition involves a a patient's bladder protruding through the abdominal wall. In females, epispadias is often accompanied by a bifid clitoris. It occurs when the clitoris itself is divided into two parts.

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