Hypospadias - Surgery, Capitate And Stem Hypospadias In Boys

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Hypospadias

The content of the article:

1. Causes and risk factors
2. Forms of the disease
3. Symptoms
4. Diagnostics
5. Treatment
6. Possible complications and consequences
7. Forecast
8. Prevention

Hypospadias is a congenital malformation of the genitourinary system, in which there is an incorrect location of the opening of the urethra (urethra). Hypospadias is one of the most common malformations of the lower urinary tract in men (after phimosis and meatostenosis); in the general structure of urological pathology, it is 1–4%. In women, hypospadias is rarely diagnosed.

Source: androlog.net

Causes and risk factors

The main reason for the formation of hypospadias is a violation of the process of differentiation of the rudimentary epithelium, as well as the closure of the urethra trough, which occur at the 7-14th week of pregnancy.

Risk factors affecting a woman during pregnancy include:

• endocrine disorders;
• infectious diseases;
• conception by in vitro fertilization;
• complicated pregnancy (early toxicosis, nephropathy, threat of termination of pregnancy);
• taking certain medications;
• alcohol abuse;
• severe psychoemotional shock;
• exposure to ionizing radiation.

Genetic predisposition plays an important role in the development of the disease. Familial cases of hypospadias are recorded in 10–20% of the total number of cases. According to some studies, an increased risk of having a baby with hypospadias is noted in vegetarian parents, which is due to the intake of large amounts of phytoestrogens with food.

Forms of the disease

Depending on the degree of underdevelopment of the urethra, the following forms of hypospadias are distinguished:

• capitate;
• coronal;
• stem;
• scrotal;
• perineal;
• hypospadias of the chord ("hypospadias without hypospadias").

In addition, pathology is classified into three groups:

• anterior (capitate and coronal);
• medium (stem);
• back (scrotal and perineal).

Source: simptomer.ru

Hypospadias in women is of two degrees:

1. The external opening of the urethra is located in the middle or lower part of the vagina, urination is not disturbed.
2. Total splitting of the posterior wall of the urethra, which extends to the sphincter area, develops urinary incontinence.

Symptoms

The clinical picture of hypospadias varies depending on the form of the disease. A common symptom is underdevelopment of the distal urethra. In men, a short fibrous cord forms, which leads to curvature of the penis. The degree of curvature depends on the length of the fibrous notochord and the density of the scar tissue. The foreskin is split during hypospadias and covers the head of the penis. The corpus cavernosum may be underdeveloped or completely absent in one or another part of the distal part of the urethra. In the absence of damage to the sphincter, urine is generally well retained.

The most common (75% of cases) and mild form of the disease is capitate hypospadias, in which the external opening of the urethra is located slightly lower than usual, it can be narrowed (meatostenosis), which causes difficulty in urinating, while the bridle is absent. In patients, there is a curvature of the penis, which increases with the onset of sexual activity.

With the development of the coronary form of the disease, the external opening of the urethra is located at the level of the coronary sulcus, urination disorders and pronounced curvature of the penis are noted.

Stem hypospadias is characterized by the inability to urinate normally in a male pattern, which forces patients to lift their penis to the stomach or to urinate while sitting. Patients have a pronounced deformation of the penis, an erection is usually accompanied by pain. With this form of the disease, sexual contact is possible, however, if the external opening of the urethra is located at the base of the penis, ejaculate does not enter the vagina.

The scrotal form of the disease has a severe course. The external opening of the urethra in this case opens on the scrotum, splitting it into two parts. There is a pronounced underdevelopment and curvature of the penis, which resembles a hypertrophied clitoris, which is why, at the birth of boys with scrotal hypospadias, it is sometimes mistaken for girls with adrenogenital syndrome. Urination is possible only in a sitting position; sexual activity is impossible.

With the development of perineal hypospadias, the external opening of the urethra is located behind the scrotum. The length of the penis does not exceed 9.5 cm (small penis). Splitting of the scrotum is noted, which can lead to an error in determining the sex of the newborn child. Scrotal and perineal forms of hypospadias are often combined with inguinal hernia, hydrocele (dropsy of the testicular membranes), cryptorchidism (undescended testis into the scrotum).

Patients with chordal hypospadias have a short, underdeveloped urethra, which causes the penis to bend downward. The external opening of the urethra is positioned correctly. During an erection, the penis bends, which is accompanied by significant pain and makes intercourse impossible.

Hypospadias in women is characterized by vaginal ectopia of the external opening of the urethra. A significant shortening of the urethra becomes the cause of the occurrence and frequent relapses of infectious diseases of the urogenital tract. Patients often develop vulvitis, vulvovaginitis, cystitis, urethritis, etc. In addition, there may be signs of pseudohermaphroditism or hermaphroditism, which is the cause of psychological problems. Total hypospadias in women is accompanied by urinary incontinence.

Diagnostics

In most cases, hypospadias is detected when the child is examined by a neonatologist immediately after birth. If a newborn has genital anomalies, an ultrasound examination of the pelvic organs is performed to determine the sex, and if this is not enough, they resort to determining the karyotype.

During an objective examination of the patient, attention is paid to the localization of the external opening of the urethra, its shape and size, the presence of curvature of the penis.

Since hypospadias in boys is often combined with other anomalies in the development of the urogenital tract, a detailed examination is carried out using (if necessary) magnetic resonance imaging of the pelvis, urethrography, urethroscopy, uroflowmetry, etc.

Treatment

The main goals of the treatment of hypospadias in boys are to restore the functions of the penis and eliminate the cosmetic defect. The most effective early treatment of the disease, undertaken at the age of 1-3 years.

With a slight dystopia and a narrowing of the external opening of the urethra, metatomy is sufficient, that is, dissection of the meatus in order to expand it. In other cases, they resort to plastic surgery of the urethra using grafts and local flaps. The operation for hypospadias can be carried out in one or two stages (the second stage is at 7-8 years old, when the penis reaches a certain size, and there are no erections yet). One-stage surgical treatment of hypospadias is preferred. In the course of surgery, penile curvature is corrected (fibrous adhesions are eliminated, plastic of the ventral surface of the penis is performed), and the absent urethra and the normally located external urethral opening are recreated. In the presence of cryptorchidism, the testicle is simultaneously lowered into the scrotum. After an operation performed in childhood, patients are observed by a pediatric urologist until the growth of the penis is completed.

Source: myfamilydoctor.ru

Surgical treatment of hypospadias in women is indicated in the case of the development of a total form of pathology. During the operation, the urethra is formed from the wall of the bladder or vagina. In other, less severe cases, surgical correction is not required. Pregnancy planning in patients with hypospadias should be carried out in accordance with the doctor's recommendations.

If the patient has psychological problems, it may be necessary to work with a psychologist or psychotherapist.

Possible complications and consequences

Hypospadias is complicated by constant irritation of the skin at the exit site of the urethra, infectious diseases of the genitourinary system, and reproductive disorders. The negative consequences of surgery for hypospadias can be a fistula of the urethra, strictures of the urethra, diverticulum of the urethra, loss of sensitivity of the glans penis. Complications leading to a decrease in the quality of life are more often observed in the scrotal and perineal forms of the disease.

Forecast

With timely diagnosis and early treatment, the prognosis is favorable in most cases. Early correction allows you to achieve normalization of the development of the penis and the process of urination.

Prevention

There is no specific prevention of the disease. Non-specific prevention of hypospadias is the elimination of factors that can negatively affect the formation of the fetus during pregnancy.

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Anna Aksenova Medical journalist About the author

Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".

The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!