Hypospadias
Hypospadias is a congenital anomaly seen in approximately one in 300 male babies. In this anomaly, the urinary canal called the urethra is underdeveloped and cannot reach the tip of the penis. The urethra does not open at the tip of the penis, but somewhere under the penis. In these patients, the foreskin is also half; While covering the back of the head of the penis in the form of a hood, the lower part of the head of the penis is exposed. For this reason, it is also called “The Prophet is circumcised”, “circumcised from birth” or “half circumcised”. In fact, these patients are not born circumcised, because the urinary canal is underdeveloped, the lower part of the foreskin does not develop and remains unfinished.
Hypospadias is an anomaly that can be easily recognized by an examination from birth. The urethra can open anywhere between the head of the penis and the root of the scrotum (bags). This makes the difference between mild, moderate and severe forms of hypospadias. In severe forms of hypospadias, curvature of the penis during erection, called chordia, accompanies the disease. In mild forms, the urethra is closer to the head of the penis. Even if there is curvature (cordia) in the penis during erection (hardening), it is not very heavy. In medium forms, the urethra opens somewhere in the middle of the penis. In these patients, mild to moderate chord accompanies the condition. In severe forms, the urinary hole opens to the root of the penis and even between the scrotum (bags). Curvature in these can also be very severe.
Diagnosis:
The diagnosis of hypospadias can be made easily during normal examination from birth. Usually, no additional examination is required. However, some additional tests may be required in severe forms. Especially in severe forms, there may be other problems related to the kidneys and urinary tract, so it may be necessary to evaluate with a detailed urinary system ultrasonography.
Treatment:
The main purpose in the surgical treatment of hypospadias is to move the urinary hole to the tip of the penis where it should be anatomically, and at the same time to correct the curvature, if any. If the curvature is not corrected, it will cause problems during erection and sexual intercourse.
This operation should be performed by Pediatric Surgeons and Pediatric Urologists experienced in hypospadias surgery. The important thing here is that your doctor should have a good command of the physical, physical and psychological characteristics of children and should have training on this subject, as well as children’s surgery. It should not be forgotten that there are great differences between a child and an adult. A child should never be approached in the same way as an adult. For this reason, the treatment process should be carried out by a surgeon who knows and observes all the physical and mental characteristics of the child and performs his/her practices accordingly. Contrary practices can lead to negative experiences in both children and families and to experience many other problems in the future.
Hundreds of surgeries have been described for hypospadias surgery. Many of them are outdated and not used in history. Here, it is important that the surgeon applies the most experienced surgical technique. While mild and moderate hypospadias can be treated with a success rate of up to 90% with single-session operations, two-session operations may be required in severe forms.
Patients with hypospadias should not be circumcised before the operation. Because the foreskin can be used while creating the urinary canal. In addition, circumcision is performed at the same time in patients undergoing hypospadias surgery. Therefore, it is important not to circumcise the patients. Hypospadias surgery may be more problematic in circumcised patients.
The timing of the operation is also important. The operation(s) should be completed by the age of 2.5 years, when the child begins to recognize his or her sexual identity. In our clinical practice, we recommend that surgical treatment should be performed after the patient is 6 months old (preferably at the 8th-9th month) and that the operations should be completed until the patient is 18-24 months old.
The duration of the operation varies according to the severity of hypospadias and whether the surgery to be performed is one or two sessions, but it varies between 1.5 and 4 hours on average. Operations are carried out on a daily basis; There is no need to stay in hospital. There is a dressing and a probe in the operation area. Having a diaper on the patient’s bottom does not prevent the operation. With the double diaper application, the patient and his family quickly return to their daily life. The dressing is opened on the second or third day, and the catheter is removed on the 7th day. After that, he can take a bath.
Complications:
Success rates in hypospadias operations performed by experienced pediatric surgeons and pediatric urologists are over 90%. The complication rate may be slightly higher in severe forms. Operations performed by surgeons with no pediatric experience have a higher rate of surgical complications and more negative psychological experiences.
The most common complication is fistula development. This means that there is a thin leak through the seam. It is not a complication to be feared and can be repaired with a much simpler and probeless surgical intervention 6 months after the operation. In addition, complications such as infection at the wound site, opening of all the sutures, and development of stenosis in the urinary canal can also be seen. Their rate is very low.
