Dear parents, first of all, this condition in your child is a treatable ailment. Depending on the condition of the current ailment, one or more surgeries may be required. Sometimes, due to the nature of the operation itself, this may already be two-session. Please research thoroughly, have enough information about the situation and then have a well-equipped physician perform the operation.
What is hypospadias?
Hypo (bottom, down) means spadiac (opening, slit, hole, crack).
It develops as a result of an abnormality in the development of the urethra (the urinary tract between the urinary bladder passing through the penis and the tip), the lower part of the penis and the foreskin in the lower part of the penis. It is also called congenitally circumcised, half-circumcised, since there is no skin on the lower part of the penis and some on the sides, as it seems circumcised.
The opening is named after the place where it opens from the tip of the penis to the lower side. Glanular (head of the penis), coronal (the groove between the body and the head), subcoronal, (under the corona) penile (penis body), penoscrotal (such as bag and penis junction, scrotal (bag), perineal (between the bag and anus).
The place where the urethra opens is different, as well as the structure of the hole, its opening diameter and shape
There may be types where the urethra can be thin or thick, and the tissue covering it is weak
Also, the urethra may be wide or narrow grooved
Glans (head) may be flat, the structure of the glans
There is also downward curvature of the penis in 25% of patients (this is called chordia). is there? (980 0703)
In addition to undescended testis and hernia, the patient is also seen. It is more common in proximal (penoscrotal, scrotal, perineal) hypospadias. Although additional testing is not often required in children with hypospadias, if there are other organ anomalies, additional testing should be performed.
How common is it?
Although similar rates are found in almost every country, rates such as one in 125/1, 150/1, 250/1, 300/1 live male births have been reported.
What is the reason?
Although the exact cause is unknown, there are many studies to explain it.
Hormone receptor disorders can be shown as the cause in very few of the septor disorders, but there is no definite condition.
It is thought that gene disorders, which are responsible for the developmental connections of some tissues with each other, play a role.
There are also studies showing that vascular developmental disorders are responsible.
It has been shown in experimental studies that genetic molecule communication disorder between tissues causes hypospadias.
There are findings that some gene mutations are also responsible
Although studies are continuing that some enzyme deficiencies play a role, there is no definite conclusion.
Progestin is responsible for some cases.
There are studies about it being seen in the children of vegetarian mothers. These are thought to be caused by plant-derived hormone modifiers.
There are studies that show that the bad effects of environmental factors on hormonal systems may play a role in the development of hypospadias.
It has also been reported that some synthetic or environmental natural chemicals cause hormonal interactions and negatively affect the development of the endocrine and reproductive systems
What is the treatment age?
Ideally, it should be done between 6-18 months. In this time period, the surgery can be tolerated better by the child. The child does not remember the trauma of the surgery in the future. In addition, this age is appropriate because it coincides with the age at which core sexual development begins.
What is the cure?
There are over 350 described surgical methods for the correction of hypospadias. All of these techniques, most of which are modifications or improvements of each other, are basically within the framework of certain main principles.
The main purpose of the treatment is to correct the curvature of the penis, if any
It is to repair the urinary tract in such a way as to urinate from the tip of the penis
To improve the cosmetic appearance.
For this reason, the following procedures are applied
The urethra is freed and its length is brought to the head
The glans (head) part is made into a tube and a new urinary tract (urethra) is made
Tube making using the foreskin
The foreskin is freed from the upper part of the penis and brought to the lower part and a new urinary tract is made from it. This intervention can be done in one or two sessions.
(So the child with hypospadias problem should definitely not be circumcised before corrective surgery.)
Constructing the urethra using the skin of the penis itself.
If there is no foreskin or if the desired result could not be obtained despite using existing skin due to previous techniques, or if new skin tissue is needed in the corrected penises because the curvature continues, then other alternative tissues can be used. Some of these are those. Free grafts taken from thin and hairless skin in the inner lip or cheek mucosa (thin tissue), behind the ear or in the groin, use of the skin of the bag or use of the membrane covering the testis.
Unfortunately, these techniques and the use of these tissues are sometimes a last resort. Therefore, it is very important not to have circumcision.
What are the complications of surgery?
Although there may be bleeding, swelling, separation of the incision site, occlusion of the catheter, and protrusion of the catheter in the early period, the most important complication is the condition called fistula, which can be even in the most skilled hands. Fistula is the return of urine from the lower part of the penis despite the repair.
Stenosis at the tip of the penis
Stenosis in the urethra
Continuation of the curvature
Complete opening of the new urinary tract
Pipi called diverticulum ballooning of the newly formed urinary tract in the lower part
What is the catheter and is it always used?
Although not sometimes used in the repair of hypospadias located at the very end, tubules or catheters made of silicone or some materials, which are placed in the urinary tract, which we call the catheter, are used both for passing urine and acting as a mold for the newly formed urinary tract. Sometimes these are sent into the urinary bladder and the tip is connected to the urinary bladder, while sometimes there are probes located only at the tip of the penis. Practices differ according to the surgeon’s style and principles. Sometimes it is also possible that no probe is used at all.
How long to stay in hospital.
Repairs of very extreme hypospadias may take 1-3 days, while those located more proximal may take 5-7 days. The surgeon’s approach and style also play a role.
Does it have an effect on sexual functions in later ages?
If any curvature is corrected, it does not have a negative effect.
