Hypospadias (half-circumcised, peeing under the pips)
What is hypospadias:
As a result of disruption during the development of the pixie in the early stages of pregnancy, the urinary opening is located in the lower parts of the pips, not at the tip of the pips. degrees of curvature and the underdeveloped part of the foreskin is called hypospadias.
How it occurs, what are the causes:
The critical period in the differentiation of external genital structures in male and female directions is 8-12th of pregnancy. With the effect of testosterone hormone in men, the phallus, which is the body part of the penis, lengthens, the open urinary canal is formed by closing from the bottom up, towards the tip of the penis, and the development is completed with the formation of the foreskin. With the interruption of this process, there is a disruption in the development of the pipi and various degrees of hypospadias disease occur depending on the level of openness of the urinary canal. Causes of the disease include: testosterone hormone deficiency, enzyme deficiency that converts the hormone to its effective form (5 alpha reductase), or lack of effect in target tissues, exposure to excess estrogen.
What are the types (classification) of the disease:
The urinary tract is formed by closing from the lower part of the bags to the tip of the penis, the glans (pipi head) is closed and the foreskin is formed, and the process is completed. At which level the closure of the urinary canal has stopped, hypospadias disease occurs at that level. In proximal, severe hypospadias, closure is stopped very early, the urethra is at the level of the bags or even lower, in the perineum, and the pipi is curved and small. In distal, milder hypospadias, the process is stopped late, and the urethra is close to the tip of the pipi. Depending on the severity of the disease, the urethra may be at various levels, from under the bags (perineum) to near the tip of the pips. There is more than one type of classification of hypospadias, but we can practically divide them into three levels: distal hypospadias, near the tip of the pixie, penile, in the body of the pixie, in the middle, proximal, at the bottom of the pixie, between or below the bags.
Things to do before surgery:
The incidence of additional disease is low in children whose urethra is very close to the tip of the pipi. However, additional diseases of the urinary tract or genital organs should be carefully investigated in children who urinate from below the pips and through the bags. For this, imaging methods other than routine blood tests are used. Urinary system ultrasound, imaging of the bladder and urinary canal with contrast material is performed, Cystoscopy is performed, that is, urinary canal and bladder are examined with a camera, internal genital structures, vagina, uterus of girls opening to the urinary canal can be found. Severe hypospadias should be investigated in terms of gender development disorder.
When to be operated on:
Hypospadias surgery is performed as early as possible, after 6 months and before one year of age. Because post-operative care is very important, protecting the pipi area from traumas such as friction, impact, and pressure is very effective in healing and preventing complications. Children are easier to care for and pain control before they crawl or walk, which also positively affects recovery. However, the surgical procedure in small size pipi is a bit more difficult and requires advanced surgical experience.
How is the surgery, what is done:
In hypospadias surgery, the urinary hole is basically brought to the tip of the penis, the curvature of the penis is corrected, the lack of skin in the lower part is completed and the shape of the head of the penis is corrected. If the distance between the tip of the pipette and the urethra is short, and there is enough tissue to form a urinary canal in between, a single-stage surgery can be planned. However, if the distance is far and the tissue is insufficient, if there is too much curvature in the pipi, a two-stage surgery is planned. In the first stage, the curvature is corrected and the mucous membrane of the foreskin or intraoral mucosa is placed between the pipi tip and the urinary hole to create a new urinary canal. In the second stage, a new urinary tract is easily created from this mucosa and the pipi head and glans can be corrected. After the surgery, a urinary catheter is inserted for the healing of the new urinary canal and this catheter remains in place for 7-14 days. After the catheter is removed, it is checked for urinary leakage (fistula) or stenosis.
Postoperative considerations:
Treatment and care after hypospadias surgery is very important. A careless and inadequate care seriously increases the complications. Surgery is recommended as early as possible (between 6 months and one year), since the care of young children and the protection of the surgical site are much more comfortable than in older ages. Generally, the dressing is not opened for the first 4 days, after it is opened, the treatment is applied and closed again, and it is repeated in this way until the catheter is removed. After the catheter is removed, it is followed up for a week with local care and a warm water bath, stenosis or leakage in the urinary canal is checked.
Postoperative complications:
There are two most common complications of hypospadias surgery; narrowing of the urethra and leakage (fistula) formation. Apart from this, complications such as the continuation of the pipi curvature, the complete opening of the new urinary canal, and the deformity of the pipi head can be seen. The longer the new urethra is, that is, the farther the urethra is from the tip of the penis, the greater the risk of complications. If stenosis and leakage occur, first of all, dilatation and widening of the urinary canal is performed, but if it continues, fistula repair can be planned at least 6 months after the operation.
