Hypospadias (in children)
Summary/Definition
Hypospadias is an anomaly in which the location of the urethral orifice through which urination is carried out does not correspond to the norm. In the case of hypospadias, the urethral opening is located in the skin area of the lower part of the penis, and in more serious cases, even in the scrotum or perineum. This congenital disorder is relatively common and occurs in 1 out of 300-500 newborn male infants. Hypospadias are caused by abnormalities in the development of the urethra during fetal development. External reproductive organs, including the urethra, begin to form at the 8th week of fetal development and end around the 15th week. In the lower part of the penis of the fetus, a urethral fold containing a urethral plate is formed, followed by gradual closure with the end of the urethra, due to which a penile urethra is formed. If the folds of the urethra do not close during this process, hypospadias occur. Depending on the location of the external urethra, hypospadias can be classified as head, penile, scrotal and perineal. Hypospadias cause defects in the urethra and cavernous bodies. The fibrous tissue that replaces the fascia in the area of the defect is called a string and can cause curvature of the penis. At the same time, the closer the external urethra is located to the root of the penis, the stronger the curvature. In addition, depending on the location of the abnormal external urethra, hypospadias can be divided into hypospadias of the glans, coronal sulcus, penis, penoscrotum, scrotum and perineum, as well as anterior, central and posterior hypospadias. Hypospadias of the glans or distal penis account for 70% of all cases.
Symptoms
The symptoms of hypospadias become more noticeable as the urethral opening approaches the perineal area. The direction of the urine stream becomes difficult, urine splashes, and if the opening of the urethra is in the scrotum or perineum, urination in a standing position becomes problematic. Adults cannot have sexual intercourse due to penile curvature associated with hypospadias, and this is often combined with cryptorchidism. If the external genitalia are ambiguous and both testicles cannot be felt, chromosomal testing may be required to determine the sex.
Diagnostics
To establish a diagnosis, it is necessary to conduct a physical examination in order to assess the location of the external urethral opening and the degree of curvature of the penis. If sexual disorders are suspected, chromosomal and hormonal studies are performed, and also confirm the development of internal reproductive organs using cystourethroscopy. If there is a suspicion of congenital abnormalities in the kidneys or ureters, then an ultrasound examination of the kidneys may be required first of all.
Treatment and course of the disease
For the treatment of hypospadias, there is only a surgical method. The main purpose of the operation is to correct the curvature of the penis, as well as to create a new urethra of the necessary length to ensure normal urine output into the urethra. Depending on the location of hypospadias, from 1 to 2 operations are required. The first stage of the operation is aimed at correcting the curvature of the penis and the formation of a new urethra. The oily skin on the back of the penis is mainly used. In cases with severe hypospadias, when the surrounding skin is insufficient, for example, when the urethral opening is located in the scrotum or perineum, a two-stage operation may be required, including autologous skin transplantation from other parts of the body. It is important to operate on children at an early age, up to 18 months, since postponing the operation can lead to psychological problems when the child begins to realize his sexual identity.
Complications
Complications such as a cutaneous urethral fistula may occur, in which urine flows out of the newly created urethra due to surgery to correct hypospadias, urethral stricture, which is a narrowing of the urethra, continued curvature of the urethra and diverticula of the urethra. If complications occur, they are usually corrected surgically after 6 months. In most cases, urethrocutaneous fistulas can be corrected with a simple surgical operation.
