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Female epispadias: are we missing the diagnosis?
Lee Allen1, Arry Rodjani, Justin Kelly
1Department of General Surgery, Royal Children's Hospital, Parkville, Victoria, Australia.
BJU International
|August 27, 2004
Summary
Female epispadias may be more common than previously thought, with subtle signs often missed by clinicians. Early diagnosis is crucial for managing urinary incontinence in young girls.
Area of Science:
- Urology
- Pediatric Surgery
- Medical Diagnostics
Background:
- Epispadias is a rare congenital anomaly in females, typically presenting with obvious external genitalia malformations.
- Previous incidence estimates for female epispadias are as low as 1 in 480,000 live births.
- Subtle variants of female epispadias may be underdiagnosed due to a lack of apparent external signs.
Observation:
- A 10-year review identified 4 female patients with epispadias out of 636,698 live births.
- Three of the four female patients presented with subtle signs and seemingly normal external genitalia.
- Key diagnostic indicators included a palpable pubic symphysis gap and an oblong external urethral meatus, even in mild cases.
Findings:
- The incidence of female epispadias is estimated to be at least 1 in 160,000 live births, potentially three times higher than previously reported.
- Subtle epispadias can lead to urethral sphincter incompetence and chronic urinary wetting.
- A bifid clitoris is an associated sign but not consistently present in all cases.
Implications:
- Clinicians must maintain a high index of suspicion for female epispadias, especially in cases of unexplained chronic wetting.
- Thorough physical examination, including assessment of the pubic symphysis and urethral meatus, is essential for accurate diagnosis.
- Early identification and management of female epispadias can improve outcomes related to urinary continence.