Epispadias is an uncommon condition in which the urinary opening is on the top of the penis, most often near its base. The penis is usually bent upwards and there is a partial foreskin on the underside. Epispadias most often occurs in boys with bladder exstrophy, but can also develop alone.
The penis with epispadias has been seen on imaging studies to be shorter and wider than usual. Boys with epispadias often have upward curvature of the penis, which at puberty results in the head of the penis pushing against the stomach and creates difficulty for sexual relations. Surgery is done to straighten the upward bending, move the opening to the tip of the penis, and to correct the foreskin – most often with circumcision, although we have been able to restore the foreskin when caregivers prefer that.
When the goals of epispadias surgery have not been achieved, such as if prior surgery has left the upward curvature incompletely straightened, or if there is deficient skin of the penis, reoperation for these persisting problems can help.
Boys with epispadias. Distal epispadias is seen in (A), while the more typical severe type is shown on the right (B), called peno-pubic epispadias. In patients with peno-pubic epispadias, the urinary opening is at the base of the penis (arrow) and the partial foreskin on the underside is being used to pull the penis down towards the feet, since the penis is often curved and tethered upwards towards the belly. Reconstruction involves moving the urinary opening to the tip of the penis, straightening the penis, and performing either a circumcision or foreskin reconstruction.
The post-operative appearance of the penis after correction of epispadias with circumcision (C), and epispadias repair with foreskin reconstruction (D).