Hypospadias is one of the most common urinary system anomalies in boys. It is seen in one of 250 boys. It is caused by hormonal and genetic factors. Typically, it is characterized by the absence of the foreskin covering the glans penis anteriorly and the urinary opening at any level anteriorly towards the root of the penis, rather than at the tip of the penis where it should be. It is defined as 'the prophet circumcised', 'half-circumcised', 'double-hole' among the people
How does it develop?
Although the exact cause of development is not known. It is predicted that it develops under the influence of genetic, hormonal and environmental factors during development in the annr womb. During development, the urinary tract (urethra) runs along the penis and extends to the tip of the penis. Due to the disruptions during this development, the elongation is not complete and stops anywhere before it reaches the tip of the penis. This place becomes the place where the urinary hole opens. When the development is not complete, the foreskin in this part also develops incompletely and the semi-circumcised state occurs.
A genetic cause can be found in only 30% of children with hypospadias. The probability of the brother of a child with hypospadias being hypospadias is 9-17%. Developmental delay during development in the womb, placental insufficiency, premature and low-weight birth, and delivery after in vitro fertilization increase the risk of hypospadias.
How is it diagnosed?
Hipospadias is usually easily identified at the time of the first examination after birth. It is evident that the foreskin is missing in the front, the urethra is lower than the tip of the penis, and in some cases, the curvature of the penis (chordee).
In some cases, although the urethra is lower, since the foreskin develops normally, this situation is mostly evident during the circumcision when the foreskin is pulled down. In this case, the hypospadias must be operated before circumcision is performed.
In some less common cases, the urinary hole is much lower - at the level of the testicles, the curvature of the penis is much more serious, if the penis is longer may be three. At this time, gender may be difficult to determine (Sexual Developmental Disorder) and additional examinations may be needed.
What types are there?
The disease of hypospadias is divided into several types according to the level of the opening of the urinary hole. In general, it is divided into light type if the urethra is close to the tip of the penis, medium if it is in the middle parts, and heavy if it is towards the root of the penis or below. Mild and moderate hypospadias is seen in the vast majority of children (70%). The incidence of the severe type is 30%. As the degree of hypospadias gets worse, the incidence of other accompanying diseases increases. The most common co-morbidities are inguinal hernia and undescended testis. Mild to moderate degrees often have no additional disease and are treated with one-stage surgery. However, in severe types, there may be more than one comorbid disease. In cases of accompanied one or two undescended testicles, children should be evaluated for Sexual Development Disorder. Severe cases usually require several-stage surgeries.
How is it treated?
Hypospadias The treatment is surgery. Circumcision is not performed in cases that are noticed during birth or later. Pediatric Surgery is performed under general anesthesia. If there is a curvature in the penis, it is corrected, and the urinary tract is extended with special techniques to the tip of the penis. The previously deformed glans penis is turned into a normal conical shape. Afterwards, circumcision is performed. A silicone catheter is used to protect the newly formed urinary tract and to form a mold during the surgery. Dressing is done at the end of the surgery. The dressing is opened in 3-5 days, the urinary catheter is removed in all 7 days. In some cases, these times may vary. Although mild forms require one-stage surgery, severe forms may require several-stage surgery. After the operation, the child is hospitalized for one day. They are discharged afterwards
When is the surgery required?
Children diagnosed with hypospadias should be operated between 6 months and 18 months . Before 6 months, the risk of anesthesia and penile length k Since it may be small, it would be appropriate to wait. Apart from this, since the period between the ages of 2 and 6 is the period when children discover their sexual identities, any intervention to the sex organ in this period may cause children to be affected psychologically.
Complications seen after surgery?
There may be some complications in the early and late period after surgery. While bleeding, infection, edema, and urinary tract infection are seen in the early period, conditions such as uretacutaneous fistula, stenosis, diverticulum, and wound opening may be seen in the late period. Fistulas, which are the most common long-term complications, are the situation where the newly constructed urinary tract opens towards the skin from any place and urine comes out from there. When it develops, it is necessary to wait 6-12 years after the operation to correct it.
Read: 0
