Hypospadias is a disease known for the anterior part of the urinary tract (urethra), which is located between the urinary bladder (bladder) and the tip of the pipi, is not fully developed and remains open, and the pipi is inclined towards the bags (cordia). Since the normally displaced urethra is as narrow as a pinhole, it may need to be enlarged before surgery. For this reason, it is very important that children with hypospadia are followed up in clinics that treat this disease from birth, even if the surgery is not urgent.
Since the foreskin is not developed in most of the patients (95%), it is seen gathered on the dorsal part of the penis. In some mild patients (5%), the foreskin is normal and the presence of the disease can only be seen after the foreskin is stripped or the child is circumcised by someone who does not know about this disease. Since the foreskin is used in surgeries to correct this hypospadia, it is very important that patients are not circumcised before the surgery.
Depending on the degree of the disease, the hole where the urine comes out (meatus) can be anywhere from just in front of the anus (anus) to the lower part of the head of the penis (glans). In very severe degrees, it may not be clear whether the child is a girl or a boy. In some cases, the true sex of the child can only be determined by chromosome examination. Since the development of the penis is often retarded in severe patients, it may be necessary to apply hormone therapy in the form of needles or creams to enlarge the penis before the surgery.
In addition to the above, some patients may have developed a pipi turned right or left (rarely facing completely backwards).
Some patients may have additional disorders of the urinary tract, kidneys or eggs (testicle). The presence of such disorders is investigated before hypospadia surgery and additional treatment is applied if necessary.
Hypospadia does not cause infertility unless there is a disorder in the eggs (testes) and hormone organs together. In very mild degrees, the patient can lead a normal life and have children even without surgery
Since the most appropriate age for the correction of hypospadias depends on the degree of the disease, the size of the penis and the characteristics of the tissues to be used in the surgery, it is determined for each patient individually.
The following surgical techniques are mainly applied according to the degrees of the disease:
In the mildest ones (the urethra is located very close to the tip at the head of the piping, but its shape is distorted or narrow, there is no curvature in the pipi); Meatoplasty, which is the enlargement or correction of the urethra, and glanuloplasty operations. *SINGLE SURGERY
Moderate ones (the urethra is between the lower part of the head of the penis and the middle of the penis, there is no curvature in the penis); surgery to make a tube with the skin there, from the urethra to the upper part of the penis. *SINGLE SURGERY
In severe cases (pipi is smaller than normal and very curved, the urethra is usually lower than the middle part of the pips); surgery to correct the curvature and to make a urine tube using the skin and foreskin there. In this group of patients, it may sometimes be necessary to correct the penis first, move the foreskin to the lower part of the penis, and perform the main corrective surgery 6 months later. *Sometimes TWO STAGE SURGERY
Conclusion: As stated before, the goal in patients with hypospadias is to achieve complete recovery with a single surgery. The success rate of the surgery is approximately 95-100% in mild grades, 85-90% in moderate grades and 60-85% in severe grades, with a single surgery.
