Hypospadias is a congenital anomaly of the urethra (MK), or rather, the incorrect location of its opening (meatus). In girls, pathology is very rare. Such a violation develops in the early stages of embryogenesis, when the fetus undergoes the laying of organs of the MPS (genitourinary system). Violation is often detected even in the hospital, when each child is examined by a neonatologist.
Statistics
Since the 70s of the last century, hypospadias has gained a tendency to spread. If in the 80s she met with a frequency of 1: 500, today the frequency is 1 to 130-145.
What happens with hypospadias?
Along with the change in the location of the outlet of the urethral canal and the deformation of the cavernous bodies, the urethra is also disturbed. Without treatment, pathology leads to a deterioration in sexual life and infertility.
Etiology of the phenomenon
There are no answers to the question of the occurrence of pathology. A possible cause are genetic or chromosomal mutations. Also, a factor-provocateur can be a violation of intrauterine development. This is especially true for a gestation period of 7-15 weeks. At this time, MPS is formed in boys, and a woman should be especially wary of any infections, stress, stress, etc. The fetus in this period (1 trimester) becomes very sensitive to influences from the outside and inside.
What factors can play a negative role:
- smoking and alcohol addiction;
- multiple pregnancy;
- frequent pregnancies;
- poor nutrition;
- mother transfer of infection (rubella, flu);
- taking hormones - a pregnant woman can be prescribed if there is a threat of miscarriage or their level is disturbed in the woman’s body.
An interesting fact: according to the observations of doctors, lovers of hairspray during pregnancy can provoke hypospadias in their babies. Among the possible reasons are the following:
- Mutation of genes.
- Hereditary predisposition - transmitted through the father. If one of the relatives suffered from hypospadias, the incidence of pathology in the offspring will be 19%.
- Hormonal contraception, if used by a woman within a year of conception.
- IVF (in vitro fertilization) - with it during pregnancy, doctors often prescribe hormone therapy.
- Bad ecology.
- The presence of pesticides and herbicides in food products, which also have a very negative effect on the hormonal background of women.
Classification
If the normal location of the meatus is on top of the head of the penis, then with hypospadias it can be found on its posterior surface, coronary sulcus, etc. Therefore, there are forms of hypospadias:
- headache;
- coronary;
- stem hypospadias;
- scrotal;
- perineal;
- "Hypospadias without hypospadias."
In girls with hypospadias, the MK hole is in the vagina.
The capitate form (the lightest) is the most common form (75%). Member curvature is rare here. Coronary - the shape of the penis and urination are disturbed, urine flows directly to the legs.
Perineal and scrotal forms are considered particularly severe malformations. In the first case, the penis is very small and resembles a clitoris. Urination is only possible while sitting. With a perineal form, the urethra resembles a wide funnel. The penis is small, deformed.
Hypospadias can be an independent anomaly, but more often combined with other disorders. There are 120 diseases in which hypospadias is one of the symptoms:
- diseases of the heart and blood vessels, kidneys;
- congenital malformations;
- inguinal hernia;
- lack of anus;
- cryptorchidism.
Manifestations
In any form, the penis is bent. This occurs because the cavernous bodies of the penis are of normal length, and MK is shortened. This symptom is especially noticeable in adults. Another persistent symptom is dysplasia of the foreskin. It can split or hang over the penis in the form of a hood.
With the capitate form of hypospadias, the foreskin is underdeveloped. The meatus is narrowed and does not reach the top of the head. Cavernous bodies suffer little. Parents are concerned only with the strange appearance of the penis and the thinness of the stream of urine. With the coronal form, the meatus is in the coronal groove and narrowed. The foreskin looks like a hood. A stream of urine goes at an angle to the curved penis.
With stem hypospadias, the urethra opens at a different level of the stem of the penis, which is also very curved. For urination, the child, standing, must first pull the penis to the stomach. There are 3 forms of stem hypospadias in children, depending on the localization department on the hanging part of the penis (trunk).
With scrotal or penile-scrotal anomaly, the meatus is located on the scrotum or between the trunk and scrotum. Penis curvature is significant. Such a child urinates only while sitting. The external genitalia resemble the labia in women with an enlarged clitoris.
With the perineal form, the urethral opening is located on the perineum, the scrotum is split and the penis is sharply curved. Urination is only possible in a sitting position. In the external genitalia, both female and male elements are combined, therefore, an endocrinologist's consultation is required.
If a birth defect is characterized by a shortened MK length, and its external opening has normal localization, this is called “hypospadias without hypospadias”.
Treatment principles
Even a simple visual inspection can reveal a pathology. The chances of a cure are high - 95% of operations are successful. An anomaly is treated only by surgery, optimally at the age of 6 months. up to 1.5-2 years. Children do not have any memories of being in surgery. The main thing is that the operation in such cases gives the cavernous bodies the full opportunity to develop normally.
Tips for Parents
If hypospadias is detected in a baby, one should not immediately panic. It is better to conduct an examination to identify parallel pathologies. Photos of stem hypospadias look unattractive. After an accurate diagnosis is made, the operation can be carried out in one or several stages.
Problems
On the first day of life, a newborn must be examined by a neonatologist. An experienced doctor will immediately pay attention to the atypical direction of the urine stream - at an angle and curvature of the penis. Stem hypospadias refers to complex forms. She has several problems:
- inability to urinate standing;
- the curvature of the penis, which will necessarily cause problems with ejaculation and the ability to have offspring;
- psycho-emotional discomfort against the background of such a pathology.
With this hypospadias, the urethral opening is located in any part of the trunk. Photos of stem hypospadias before and after surgery are shown below. A similar form of the anomaly is accompanied by a narrowing not only at the site of the hole, but throughout.
Forms and Degrees
There may be three forms of stem hypospadias in children. We will analyze them in more detail. Classification of the disease:
- Distal stem hypospadias - while the meatus is located closer to the coronal groove.
- The central form is the urethral canal in the center of the trunk.
- Proximal forms of stem hypospadias in children - the meatus is closer to the scrotum.
According to the severity of the pathology, the following classification:
- Easy stage - the penis is curved only slightly or normal. Most often this is noted with the coronary-stem form of hypospadias.
- The middle stage - the penis is curved, and visually it is determined. This degree is often observed with the proximal form.
- Severe degree - urine output occurs immediately near the perineum, the penis is not only curved, it is hyperplastic.
Diagnostic measures
Stem hypospadias should not only be confirmed by visual inspection, but also have an instrumental basis:
- Ultrasound
- Uro- and cystourethrography;
- MRI and CT, if necessary;
- genetic tests to detect heredity in the anomaly.
Treatment
The only way to treat stem hypospadias is surgery. Her goals:
- correction of the external forms and structure of the genital organs;
- restoration of normal functions.
Correction of external forms and functioning is achieved by plastic surgery and the formation of the missing section of the urethra, creating a normal size of the lumen of the MK, correcting the deformation of the penis and completely removing cosmetic defects.
In the case of the stem form of hypospadias (photos are given in the article), the operation can be performed in several stages. Conditionally, reconstruction can be described in 3 main successive stages:
- Orthoplasty - straightening the penis.
- Urethroplasty - restoration of the missing part of the urethra.
- Penile head and meatus plastic surgery (meatoglanuloplasty).
The operation is performed under general anesthesia. The surgeon straightens the penis and creates the conditions for the normal development of the corpora cavernosa. For this, scar tissue is excised at the site of the urethral opening, which ensures the normal development of the cavernous bodies. After this, an additional urethral region is formed on the head of the penis. This will allow him to function normally. For plastics of the missing part of MK, skin is used either from the forearm or foreskin.
Types of operations
The type of operation is selected by the doctor. Allocate more than 150 species. Several have gained practical distribution:
- MAGPI surgery - effective in distal stem form. The head of the penis is made flat and the urethra does not move.
- Mathieu's operation is possible with any form of hypospadias. On each side of the urethral plate, 2 incisions are made to the very top of the head, they are deepened to the cavernous bodies. An incision line outlines a skin flap that is folded upward and sutured to the edges of the urethral plate. The lateral “wings” of the head are sutured together, first separated from the corpora cavernosa. This makes it possible to form a conical shape of the head.
- Snodgrass operation (TIP operation) - refers to the universal type of intervention. The urethral plate is dissected longitudinally in the middle from the existing external opening of the urethra up to the head and, accordingly, a tube is created from it around the catheter 8P. The uncovered dorsal section of the urethra subsequently epithelizes itself.
- It is used for any form of stem hypospadias Tirsch-Duplay operation. From the head to the cavernous bodies, the surgeon makes a deep incision on the sides, the urethral plate also tubularizes, covering it comprehensively with flaps and stitches them together.
- Plastic flap on the leg - a universal method. The flap is created from the mucous membrane of the cheek, after which they cover the plate of the urethra. After surgery, the penis becomes normal (as after circumcision). At the request of the parents, the surgeon can recreate the foreskin (prepuceoplasty).
Rehabilitation
After surgery, stem hypospadias operated on for several days in bed. After the operation, a silicone catheter is inserted into the bladder, which removes urine within the next 7-10 days. It will also help to quickly restore the tissue of a new section of the urethra. This reduces the risk of urethral-skin fistula formation.
With the stem form of hypospadias after surgery during rehabilitation in the ward, the catheter changes every 3 days. Antiseptic treatment is a daily procedure. Urethral healing occurs 3 weeks after surgery. It is necessary to prescribe male sex hormones to build them in the blood.
To prevent infection, a course of antibiotics is prescribed. Sometimes a catheter can cause spasms of the bladder, the doctor prescribes "Driptan" to remove them. Analgesics may be used in the early days.
In the case of a one-step operation, recovery takes several months. At this time, doctor visits should become regular to monitor healing.
The benefits of early surgery
During the operation of stem hypospadias in boys under 1.5 years of age, the postoperative period is most easily tolerated. There are no problems of the physical and psychological plane. Firstly, at this age, care after surgery is much easier than in 2-4 years. Secondly, the size of the penis almost up to 3 years does not change. Thirdly, a catheter for urine diversion is fixed between 2 diapers, in connection with which there is no need for the child to fix. And, most importantly, a child at this age never remembers the events of the operation.
Is an operation necessary?
In a situation with hypospadias, it is impossible to cure a child with medication. Surgery is the only treatment. Hypospadias can be eliminated at any age.
What complications may arise during surgery
A complete discrepancy of tissues in the area of operation may occur. In this case, urethral fistulas are formed, stenosis of the urethra and meatus is possible. The opposite condition is the diverticulum of the urethra. Complications are more common in adults.
Problems in adults with hypospadias
Hypospadias in adult men causes difficulty in sexual intercourse. Penile curvature prevents a full erection. Sex instead of pleasure brings discomfort.
Penile curvature causes ridicule and contempt from peers. Because of this, many representatives of the strong half fall into stress, complex, become neurotic. In addition, hypospadias can directly lead to infertility. If during the reconstruction of the urethra the skin of the scrotum was taken, it begins to become covered with hair in puberty. Urate salts will form on them with the formation of calculi. This will disrupt the urination process.
With age, if untreated, the penis continues to bend even more, urination turns into a very unpleasant problematic ritual. Pouring down urine will stain clothes and legs. Such patients at each visit to the toilet for urination should literally pull their penis to their stomach.