Tag: NEET PG

Hepatorenal Syndrome

HEPATORENAL SYNDROME


HEPATORENAL SYNDROME

  • HRS is development of acute renal failure due to severe hepatic (advanced cirrhosis) or bilary disease with jaundice.
  • Low cardiac putput and high plasma rennin predicts development of HRS.
  • Patient develops oliguria, azotaemia and hyponatraemia.

ETIOLOGY-

  • Bile salt sludging in the tubules
  • Absorption of toxins
  • Increase ADH release
  • Hypoperfusion and renal ischaemia
  • Precipitated by surgery, stress

 PATHOLOGY-

  • Increase in renal vascular resistance along with reduction in systemic vascular resistance
  • Pathogenic marker is intense renal vasoconstriction with vasodilatation

INVESTIGATIONS-  

TYPES-

1. Type 1 HRS-

  • Oliguria
  • Decrease serum creatinine
  • Poor prognosis
  • No proteinuria
  • Urine sodium excretion  <10mmol/day
  • Urine/ plasma osmolarity ration >1.5

Treatment-

  • Albumin + terlipressin

2. Type 2 HRS

  • Refractory ascites
  • Better prognosis
  • Increase serum creatinine levels

Treatment-

  • Terlipressin- DOC
  • Midodrine + pctreotide + IV albumin- reverse renal failure
  • Best therapy for HRS- liver transplantation
  • Dopamine or prostaglandin analogues for renal vasodilation

Exam Important

PATHOLOGY-

  • Increase in renal vascular resistance along with reduction in systemic vascular resistance
  • Pathogenic marker is intense renal vasoconstriction with vasodilatation

INVESTIGATIONS-  

TYPES-

1. Type 1 HRS-

  • Oliguria
  • Decrease serum creatinine
  • Poor prognosis
  • No proteinuria
  • Urine sodium excretion  <10mmol/day
  • Urine/ plasma osmolarity ration >1.5

Treatment-

  • Albumin + terlipressin

2. Type 2 HRS

  • Refractory ascites
  • Better prognosis
  • Increase serum creatinine levels

Treatment-

  • Terlipressin- DOC
  • Midodrine + pctreotide + IV albumin- reverse renal failure
  • Best therapy for HRS- liver transplantation
  • Dopamine or prostaglandin analogues for renal vasodilation
Don’t Forget to Solve all the previous Year Question asked on HEPATORENAL SYNDROME

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Hepatorenal Syndrome

Hepatorenal syndrome

Q. 1 Albumin treatment along with antibiotic in the setting of SBP(spontaneous bacterial peritonitisis indicated to prevent the development of hepatorenal syndrome is in all , EXCEPT:

 A

Serum creatine is > 1 mg/dl

 B

BUN > 30mg/dl

 C

Total bilirubin is > 4 mg/dl

 D

INR > 2

Q. 1

Albumin treatment along with antibiotic in the setting of SBP(spontaneous bacterial peritonitisis indicated to prevent the development of hepatorenal syndrome is in all , EXCEPT:

 A

Serum creatine is > 1 mg/dl

 B

BUN > 30mg/dl

 C

Total bilirubin is > 4 mg/dl

 D

INR > 2

Ans. D

Explanation:

In patients with SBP along  with cefotaxime albumin infusion is indicated in the setting , when

1.Serum creatine is  > 1 mg/dl
2. BUN >   30 mg/dl
3. Total bilirubin is > 4 mg/dl
 
Dose o f albumin: 1. g/Kg within 6 hours of antibiotic treatment and 1 g/kg  on day 3.
A decrease in mortality from 30%to 10 % is noted.
Ref: AASLD practice  guidelines:Hepatology, Vol.49 ,No.6 ,2009.

Q. 2 Features of Hepatorenal syndrome are

 A

Urine sodium < 10 meq/1

 B

Normal renal histology

 C

Renal function abnormal even after liver become normal

 D

a and b

Q. 2

Features of Hepatorenal syndrome are

 A

Urine sodium < 10 meq/1

 B

Normal renal histology

 C

Renal function abnormal even after liver become normal

 D

a and b

Ans. D

Explanation:

Answer is A & B (urine Na < 10 meq/l and Normal Renal Histology)

Hepatorenal syndrome is associated with normal renal histology and supported by a urine sodium excretion l0meq/L

Hepatorenal syndrome

  • Hepatorenal syndrome is defined as a state of functional renal failure (Reduced GFR) in patients with severe liver disease
  • Structurally /Histologically the kidneys are normal and recover function after successful liver transplantation.
  • The pathogenetic hallmark of hepatorenal syndrome is intense renal vasoconstriction with coexistent systemic vasodilatation
  • The diagnosis of hepatorenal syndrome is considered in accordance with the following diagnostic criteria.

Diagnostic of Hepatorenal Syndrome

Major criteria

  • Low glomerular filtration rate. as indicated by serum creatinine > 1.5 mg/dL or 24-hr creatinine clearance < 40 mL/min
  • Absence of shock, ongoing bacterial infection, fluid losses, and current treatment with nephrotoxic drugs
  • No sustained improvement in renal function (decrease in serum creatinine to 1.5 nig/dL or increase in creatinine clearance to 40 mL/min) after diuretic withdrawal and expansion of plasma volume with 1.5L of a plasma expander
  • Proteinuria mg/d1, and no uhrasonographic evidence of obstructive uropathy or parenchymal renal disease Additional criteria
  • Urine volume < 500 mL/d
  • Urine sodium < 10 meq/L
  • Urine osmolality greater than plasma osmolality
  • Urine red blood cells <50/high- power. field
  • Serum sodium concentration < 130 niEqL

Note: All major criteria must be present for the diagnosis of hepatorenal syndrome.

Additional criteria are not necessary for the diagnosis but provide supportive evidence.


Q. 3 Which of the following statements is incorrect with regard to Hepatorenal syndrome in a patient with cirrhosis

 A

Createnine clearance < 40 ml/min

 B

Urinary sodium < 10mq/L

 C

Urine osmolality lower than plasma osmolality

 D

No sustained improvement in renal function after volume expansion.

Q. 3

Which of the following statements is incorrect with regard to Hepatorenal syndrome in a patient with cirrhosis

 A

Createnine clearance < 40 ml/min

 B

Urinary sodium < 10mq/L

 C

Urine osmolality lower than plasma osmolality

 D

No sustained improvement in renal function after volume expansion.

Ans. C

Explanation:

Answer is C (Urine osmolality is lower than plasma osmolality):

Hepatorenal syndrome is associated with urine osmolality greater than plasma osmolality (and not lower than plasma osmolality).

creatinine clearance < 40 ml/minute and poor response to volume expansion are major diagnostic features of hepatorenal syndrome while urinary sodium of less than 10 mmol/L is an additional criteria that provides supportive evidence.

Quiz In Between


Q. 4

Hepatorenal syndrome is characterized by all of the following except:     
March 2005

 A

Reduction in creatinine clearance

 B

Managed effectively by renal vasodilating agents.

 C

Proteinuria less than 500 mg/ d

 D

Normal intrinsic kidney

Q. 4

Hepatorenal syndrome is characterized by all of the following except:     
March 2005

 A

Reduction in creatinine clearance

 B

Managed effectively by renal vasodilating agents.

 C

Proteinuria less than 500 mg/ d

 D

Normal intrinsic kidney

Ans. B

Explanation:

Ans. B: Managed effectively by renal vasodilating agents.

HRS is defined as worsening azotemia with avid sodium retention and oliguria in the absence of identifiable specific cause of renal dysfucntion in setting of acute or advanced chronic liver disease

No specific tests establish the diagnosis of HRS.

Diagnosis of HRS is based on the presence of a reduced GFR in the absence of other causes of renal failure in patients with chronic liver disease. The following criteria help to diagnose HRS:

Major criteria: All major criteria are required to diagnose HRS.

  • Low GFR, indicated by a serum creatinine level higher than 1.5 mg/ dL or 24-hour creatinine clearance lower than 40 mL/ min
  • Absence of shock, ongoing bacterial infection and fluid losses, and current treatment with nephrotoxic medications
  • No sustained improvement in renal function (decrease in serum creatinine to40 mL/ min) after diuretic withdrawal and expansion of plasma volume with 1.5 L of plasma expander
  • Proteinuria less than 500 mg/ d and no ultrasonographic evidence of obstructive uropathy or intrinsic parenchymal disease

Additional criteria: Additional criteria are not necessary for the diagnosis but provide supportive evidence.

  • Urine volume less than 500 mL/d
  • Urine sodium level less than 10 mEq/ L
  • Urine osmolality greater than plasma osmolality
  • Urine red blood cell count of less than 50 per high-power field
  • Serum sodium concentration less than 130 mEq/ L

The best therapy for HRS is liver transplantation.


Q. 5 All are true about hepatorenal syndrome except:

 A

Creatinine level raised

 B

Albumin infusion given

 C

Liver transplantation improves renal functions

 D

May occur in cirrhosis

Q. 5

All are true about hepatorenal syndrome except:

 A

Creatinine level raised

 B

Albumin infusion given

 C

Liver transplantation improves renal functions

 D

May occur in cirrhosis

Ans. E

Explanation:

Answer- E. Low dose dopamine infusion is very effective

  • The hepatorenal syndrome (HRS) is a form of functional renal failure without renal pathology that occurs in about 10% of patients with advanced cirrhosis or acute liver failure.
  • There are marked disturbances in thc arterial renal circulation in Patients with HRS.
  • TyPe I HRS- a significant reduction in creatinine clearance within 1-2 weeks of presentation.
  • Type 2 HRS- an elevation of serum creatinine level.
  • HRS is often seen in patients with refractory ascites.

Treatment-

  • dopamine or prostaglandin analogues were used as renal vasodilating medications.
  • Patients are treated with midodrine, an alpha-agonist, along with octreotide and intravenous albumin.
  • The best theragy for HRS is liver transplantation.

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Interstitial Cystitis

INTERSTITIAL CYSTITIS


INTERSTITIAL CYSTITIS (HUNNER’S ULCER, ELUSIVE ULCER)

  • Inflammation of bladder mucosa is cystitis.
  • The characteristic linear bleeding ulcer is caused by splitting of mucosa when the bladder is distended under anaesthesia
  • Severe fibrosis along with inflammation of urinary bladder due to pancystitis results in small thimble bladder.
  • Ulceration of the mucosa occurs in fundus of bladder.
  • Mast cells are often seen in the mucosa, lamina propria, and muscularis propria in interstitial cystitis.
  • Decrease bladder capacity 30- 60 ml

CLINICAL FEATURES-

  • Increase frequency
  • Initial symptom- increase frequency and pain is relieved by micturition and aggrevated by distension of bladder due to decrease bladder capacity
  • Haematuria

INVESTIGATIONS-

  • Cystoscopy and biopsy confirms diagnosis

TREATMENT-

  • Hydrostatic dilatation
  • Instillation of dimethyl sulphoxide
  • Ranitine instillation
  • Ileocystoplasty or caecocystoplasty increases bladder capacity

Exam Important

  • Inflammation of bladder mucosa is cystitis.
  • The characteristic linear bleeding ulcer is caused by splitting of mucosa when the bladder is distended under anaesthesia
  • Severe fibrosis along with inflammation of urinary bladder due to pancystitis results in small thimble bladder.
  • Ulceration of the mucosa occurs in fundus of bladder.
  • Mast cells are often seen in the mucosa, lamina propria, and muscularis propria in interstitial cystitis.
  • Decrease bladder capacity 30- 60 ml
Don’t Forget to Solve all the previous Year Question asked on INTERSTITIAL CYSTITIS

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Interstitial Cystitis

Interstitial Cystitis

Q. 1 Cells involved in interstitial cystitis?

 A

Lymphocytes

 B

Neutrophils

 C

Macrophages

 D

Mast cells

Q. 1

Cells involved in interstitial cystitis?

 A

Lymphocytes

 B

Neutrophils

 C

Macrophages

 D

Mast cells

Ans. D

Explanation:

Ans. is ‘d’ i.e., Mast cells

  • Mast cells are often seen in the mucosa, lamina propria, and muscularis propria in interstitial cystitis.

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Acute Prostatitis

ACUTE PROSTATITIS


ACUTE PROSTATITIS

  • Inflammation of prostate can be Acute or Chronic.

ETIOLOGY-

  • MC organism- E. Coli > staphylococcus aureus > staphylococcus albus
  • Instrumentation
  • Ascending and descending infection from below and above into infected urine into prostatic ducts
  • Haematogenous

CLINICAL FEATURES-

  • High grade fever, chills and rigors
  • Retention of urine
  • Perineal heaviness, pain on defaecation and micturition
  • Enlarged, tender and boggy protate- rectal examination
  • Catherization and prostatic massage is contraindicated  

INVESTIGATIONS-

  • USG abdomen 

TREATMENT-

  • IV fluids, antipyretics
  • Antibiotics- TMP- SMX, ciprofloxacin or norfloxacin (2- 3 weeks)
COMPLICATIONS
  • Seminal vasculitis

Exam Important

ETIOLOGY-

  • MC organism- E. Coli > staphylococcus aureus > staphylococcus albus
  • Instrumentation
  • Ascending and descending infection from below and above into infected urine into prostatic ducts
COMPLICATIONS
  • Seminal vasculitis
Don’t Forget to Solve all the previous Year Question asked on ACUTE PROSTATITIS

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Acute Prostatitis

Acute Prostatitis

Q. 1 Complication which commonly accompanies acute prostatitis –

 A

Epididymitis

 B

Orchitis

 C

Seminal vesiculitis

 D

Sterility

Q. 1

Complication which commonly accompanies acute prostatitis –

 A

Epididymitis

 B

Orchitis

 C

Seminal vesiculitis

 D

Sterility

Ans. C

Explanation:

Ans. is ‘c’ i.e., Seminal vesiculitis 

Quiz In Between



Carcinoma Of Prostate

CARCINOMA OF PROSTATE


CARCINOMA OF PROSTATE

  • Carcinoma of prostate is the MC malignant tumour in men over 65 years.
  • MC cause of bone secondaries
  • Carcinoma of prostate occurs in peripheral zone in prostatic gland proper (commonly in posterior lobe)

RISK FACTORS-

  • Advancing age + increase fat intake
  • Genetic alterations is hypermethylation of glutathione transferase (GSTP-1) located on chromosome 11

PATHOLOGY-

  • Adenocarcinoma of prostate is the MC form of cancer in males
  • They are multifocal and heterogenous

SPREAD-

1. Local spread-

  • Upward- seminal vesicles, bladder neck, trigone
  • Downward- distal sphincter

2. Blood spread-

  • Bones- pelvic bones, lumbar vertebrae, femoral head, ribs and skull
  • MC site of origin- for skeletal metastases

3. Lymphatic spread-

  • Obturator lymph nodes

CLINICAL FEATURES-

  • Bladder outlet obstruction
  • Haematuria
  • Commonly asymptomatic
  • Pelvic pain, back pain, arthritic pain
  • Renal failure
  • Perineural invasion
  • Rectal examination- prostate feels hard, nodular, irregular and obliteration of medial sulcus

STAGING-  

INVESTIGATIONS-

1. Hb%

  • Anemia
  • Thrombocytopenia
  • DIC

2. Plain X-ray, KUB-

  • Shows sclerotic metastases in lumbar vertebrae and pelvic bones

3. Serum acid phosphatase-

  • Responsible for acidic pH in the prostatic urethra and normally drained in urine
  • Increase acid phosphatase

4. Serum alkaline phosphatase-

  • Increase in extensive liver metastasis or bone metastasis

5. Prostate specific antigen(PSA)

  • It is a glycoprotein, serine protease elaborated by columnar prostatic acinar epithelial cells.
  • Free- 10- 40%, complexed to antiprotease- 60 to 90%
  • Formed in prostate and secreted in seminal fluid
  • Causes liquefaction of seminal coagulum
  • More than 4nmol/ml- carcinoma detected
  • 10 nmol/ml- prostatic carcinoma
  • 35 nmol/ ml- disseminated carcinoma
  • Prostate specific, but not prostate cancer specific
  • Most efficient test and for staging and assessing

6. Abdominal and transrectal USG- staging of the disease

7. CT scan or MRI scan

  • Staging of the disease
  • MRI is ideal for most accurate for local staging

8. Bone scan-

  • Increased ALP
  • Increased PSA (>20nmol/ml)
  • For diagnosing metastasis

TREATMENT-

I) Early malignancy

a) T1 a-

  • Well differentiated associated with very slow growth rate
  • Regular follow up with DRE and PSA

b) T1b T1c, T2

  • Radical prostactectomy or radiotherapy
  • External beam radiotherapy- T1 or low T2 disease
  • Branchytherapy- low T1 disease

II) Late malignancy (T3, T4 or any metastasis)

  • Androgen ablation is the first line of treatment followed by antiandrogenic measure
  • Orchiectomy + flutamide or LHRH + flutamide
  • Palliative radiotherapy

Exam Important

  • Carcinoma of prostate is the MC malignant tumour in men over 65 years.
  • MC cause of bone secondaries
  • Carcinoma of prostate occurs in peripheral zone in prostatic gland proper (commonly in posterior lobe)

CLINICAL FEATURES-

  • Bladder outlet obstruction
  • Haematuria
  • Commonly asymptomatic
  • Pelvic pain, back pain, arthritic pain
  • Renal failure
  • Perineural invasion
  • Rectal examination- prostate feels hard, nodular, irregular and obliteration of medial sulcus

INVESTIGATIONS-

1. Hb%

  • Anemia
  • Thrombocytopenia
  • DIC

2. Plain X-ray, KUB-

  • Shows sclerotic metastases in lumbar vertebrae and pelvic bones

3. Serum acid phosphatase-

  • Responsible for acidic pH in the prostatic urethra and normally drained in urine
  • Increase acid phosphatase

4. Serum alkaline phosphatase-

  • Increase in extensive liver metastasis or bone metastasis

5. Prostate specific antigen(PSA)

  • It is a glycoprotein, serine protease elaborated by columnar prostatic acinar epithelial cells.
  • Free- 10- 40%, complexed to antiprotease- 60 to 90%
  • Formed in prostate and secreted in seminal fluid
  • Causes liquefaction of seminal coagulum
  • More than 4nmol/ml- carcinoma detected
  • 10 nmol/ml- prostatic carcinoma
  • 35 nmol/ ml- disseminated carcinoma
  • Prostate specific, but not prostate cancer specific
  • Most efficient test and for staging and assessing

6. Abdominal and transrectal USG- staging of the disease

7. CT scan or MRI scan

  • Staging of the disease
  • MRI is ideal for most accurate for local staging

8. Bone scan-

  • Increased ALP
  • Increased PSA (>20nmol/ml)
  • For diagnosing metastasis

TREATMENT-

I) Early malignancy

a) T1 a-

  • Well differentiated associated with very slow growth rate
  • Regular follow up with DRE and PSA

b) T1b T1c, T2

  • Radical prostactectomy or radiotherapy
  • External beam radiotherapy- T1 or low T2 disease
  • Branchytherapy- low T1 disease

II) Late malignancy (T3, T4 or any metastasis)

  • Androgen ablation is the first line of treatment followed by antiandrogenic measure
  • Orchiectomy + flutamide or LHRH + flutamide
  • Palliative radiotherapy
Don’t Forget to Solve all the previous Year Question asked on CARCINOMA OF PROSTATE

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Carcinoma Of Prostate

Carcinoma of prostate

Q. 1 Which is the most common site of carcinoma prostate?

 A

Peripheral

 B

Centre

 C

Verumontum

 D

None of the above

Q. 1

Which is the most common site of carcinoma prostate?

 A

Peripheral

 B

Centre

 C

Verumontum

 D

None of the above

Ans. A

Explanation:

85% of prostate carcinoma arise from the peripheral zone.
Ninety five percent of tumors are adenocarcinoma.
Prostate carcinoma rarely occur before the age of 40 years, and the incidence increases with age. 

  • PSA is elevated in 60% of men with prostate cancer. Levels above 4ng/ml is considered abnormal.
  • Levels of PSA can be elevated with age and BPH. 
  • Falsely elevated PSA can be seen following cystoscopy, prostate biopsy, or urethral catheterization.
  • PSA is not elevated following digital rectal examination.

Ref: CURRENT Diagnosis & Treatment: Surgery, 13e, chapter 38


Q. 2

Trans rectal ultrasonogram in evaluation of carcinoma prostate most useful for:

 A

Taking guided biopsy

 B

Identifying seminal vesicle invasion

 C

Nodal sampling

 D

Measuring the extent of invasion

Q. 2

Trans rectal ultrasonogram in evaluation of carcinoma prostate most useful for:

 A

Taking guided biopsy

 B

Identifying seminal vesicle invasion

 C

Nodal sampling

 D

Measuring the extent of invasion

Ans. A

Explanation:

Ans. is ‘a’ Taking guided biopsy 

“TRUS is the imaging technique most frequently used to assess the primary tumor, but its chief use is directing prostate biopsies, not staging” – Harrison

  • Thus primary role of TRUS is guiding prostate biopsies
  • Other uses are

– assessing extent of invasion if cancer is detected.

– measurement of prostate volume which is needed in the calculation of the PSA density. – also used in performance of cryosurgery & brachytherapy.


Q. 3

Which is not used in carcinoma prostate ‑

 A

Estrogen

 B

Progesterone

 C

Cyproterone acetate

 D

Flutamide

Q. 3

Which is not used in carcinoma prostate ‑

 A

Estrogen

 B

Progesterone

 C

Cyproterone acetate

 D

Flutamide

Ans. C

Explanation:

Ans. is ‘c’ i.e., Conservative treatment 

Quiz In Between


Q. 4

In carcinoma prostate with matastasis which is raised

 A

ESR

 B

Alkaline phosphatase

 C

Acid phosphatase

 D

All

Q. 4

In carcinoma prostate with matastasis which is raised

 A

ESR

 B

Alkaline phosphatase

 C

Acid phosphatase

 D

All

Ans. B

Explanation:

Ans. is ‘b’ i.e., Alkaline phosphatase 


Q. 5

70 year old man with Ca.prostate with osteoblastic secondaries in pelvis and lumbar vertebra showed well differentiated Adeno Carcinoma prostate on needle biopsy. He is idealy treated by –

 A

Radical prostectomy

 B

TURP

 C

Radiation

 D

Hormonal manipulation

Q. 5

70 year old man with Ca.prostate with osteoblastic secondaries in pelvis and lumbar vertebra showed well differentiated Adeno Carcinoma prostate on needle biopsy. He is idealy treated by –

 A

Radical prostectomy

 B

TURP

 C

Radiation

 D

Hormonal manipulation

Ans. D

Explanation:

Ans. is ‘d’ i.e., Hormonal manipulation 

Quiz In Between



Epispadias

EPISPADIAS


EPISPADIAS

  • Urethra opens in the dorsum (upper aspect) of the penis in males.
  • In females, there is fissure in the wall of the urethra which opens above clitoris (uncommon)
  • MC site in abdominopenile junction
  • Associated with-

a) Dorsal chordee

b) Ectopia vesicae

c) Urinary incontinence

d) Separated pubic bone

CLINICAL FEATURES-

  • Males- glandular epispadias seldom have urinary incontinence
  • Incontinence in penopubic (95%) and penile epispadias (75%)
  • Females- bifid clitoris and separation of the labia
  • Most are incontinent

TREATMENT-

  • Surgery- correct incontinence, remove chordee and extend urethra to glans penis
  • Urinary diversion

Exam Important

  • Urethra opens in the dorsum (upper aspect) of the penis in males.
  • In females, there is fissure in the wall of the urethra which opens above clitoris (uncommon)
  • MC site in abdominopenile junction
  • Associated with-

a) Dorsal chordee

b) Ectopia vesicae

c) Urinary incontinence

d) Separated pubic bone

Don’t Forget to Solve all the previous Year Question asked on EPISPADIAS

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Epispadias

Epispadias

Q. 1 Epispadias is associated with?

 A

Bifid pubic symphysis

 B

Chordee

 C

Anal atresia

 D

Intestial obstruction

Q. 1

Epispadias is associated with?

 A

Bifid pubic symphysis

 B

Chordee

 C

Anal atresia

 D

Intestial obstruction

Ans. B

Explanation:

Ans is b i.e. chordee 

  • An epispadias is a rare type of congenital malformation in which the urethra opens on the dorsum (the upper aspect) of the penis. It is often part of the condition termed Epispadias-exstrophy of the bladder. Epispadias is a mild form of bladder exstrophy, and in severe cases, exstrophy and epispadias coexist.
  • The extent of the defect can vary from a mild glandular defect to complete defects as are observed in bladder exstrophy, diastasis of the pubic bones, or both.

–  In glandular epispadias, the urethra opens on the dorsal aspect of the glans, which is broad and flattened.

– In the penile type, the urethral meatus, which is broad and gaping, is located between the pubic symphysis and the coronal sulcus. A distal groove usually extends from the meatus through the splayed glans.

–  The penopubic type has the urethral opening at the penopubic junction, and the entire penis has a distal dorsal groove extending through the glans.

  • All types of epispadias are associated with varying degrees of dorsal chordee.
  • Females with epispadias have a bifid clitoris and separation of the labia.
  • Male to female ratio of epispadias is 3: 1.
  • Incontinence due to maldevelopment of urinary sphincters is commonly associated with most epispadias except for the glandular type.
  • Other associated anomaly is pubic diastasis as in exstrophy.
  • Surgery is required to correct the incontinence, remove the chordee to straighten the penis, and extend the urethra out onto the glans penis.

Note that pubic diastasis (i.e. separation of pubic bones) is not synonymous with bifid pubic symphysis.


Q. 2 Epispadias in relation to hypospadias ‑

 A

Is more common

 B

Less common

 C

Occures with the same frequency

 D

Is difficult to treat

Q. 2

Epispadias in relation to hypospadias ‑

 A

Is more common

 B

Less common

 C

Occures with the same frequency

 D

Is difficult to treat

Ans. B

Explanation:

Ans. is ‘b’ i.e., Less common 

Quiz In Between



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