What is hypospadias ?
Hypospadias describes the congenital absence of the urethral opening where it should be. It is the second most common congenital anomaly in boys, being 1 in 250 births.
Hypospadias is when the hole where the child urinates is under the penis, not at the tip. The urinary canal has not been fully formed in the area between this hole and the tip of the penis. Dec. Hypospadias can be classified differently according to the location of the urinary hole. Cases of hypospadias located at the head of the penis, very close to the place where the normal urinary hole should be, are called glandular hypospadias. If the penis settles at the junction between the Decapitation and the body of the penis, it gets the name coronal hypospadias. Both conditions are generally included in the definition of “distal hypospadias”, it is this group that is the most common in children, and the group with the highest surgical success rate. There are also hypospadias with a lower location, the placement of the urinary hole can be anywhere on the penis body, in the area where the penis and bags meet, or even in the area we call the perineum near the anus. Of course, surgical treatment of lower-located hypospadias is more difficult.
What are the symptoms of hypospadias ?
Hypospadias is popularly called by different names, it can be called prophet circumcised, birth circumcised or half-circumcised. The main reason for these is that the front side of the foreskin has not developed in children with hypospadias. The foreskin is located only in the back part of the penis.
There may be curvature of the penis in the case of hardening called erection, called cordi. The more severe the hypospadias anomaly is, that is, the further away the hole through which he urinates is from the tip of the penis, the more this curvature, called cordi, becomes. One of the most basic parts of the treatment in hypospadias surgery is the correction of this curvature.
Children with hypospadias prefer to pee sitting down, because when peeing standing up, they urinate downwards instead of across.
Is it a congenital condition ? How often does it occur ?
Hypospadias is a congenital condition. The cause is not known for sure. While there are some studies that hormonal stimulations are missing in the womb, some studies completely reject them.
Along with hypospadias, especially in severe cases, the presence of associated urogenital system anomalies also supports that it is congenital.
It is one of the most common conditions encountered in pediatric urology practice. Hypospadias occurs in one out of every 250 boys. Distal type hypospadias, which we call, are more common in those with a urinary canal near the tip of the penis.
The diagnosis can be easily made with a careful physical examination to be performed when the baby is born.
Should other studies be performed after receiving the diagnosis of hypospadias?
Along with hypospadias, other urogenital system disorders are also more likely to occur, especially in severe cases. For this reason, in severe cases, especially the urinary system (kidney and urinary excretory ducts, and bladder) should definitely be examined. If there is a bilateral undescended testicle with hypospadias, chromosomal research should definitely be conducted to investigate whether this condition is a sexual differentiation problem.
When should the treatment be performed?
The only treatment for hypospadias is surgery. It is necessary to avoid painful penis interventions between the ages of 2-6, the period called the phallic Deceleration, when the child discovers his sexual identity. Therefore, hypospadias surgery should be performed without discovering the child’s sexual identity. It is also easier to maintain this surgical intervention to be performed during the glandular period.
Who should perform hypospadias surgery?
There are about 500 types of surgery defined for the surgical treatment of hypospadias. Everyone claims to be able to treat hypospadias aemily; plastic surgeons, urologists, pediatric surgeons, even general surgeons. Each branch also states that it is doing this job well. However, the information we have; one out of every three surgeries performed on inexperienced hands results in complications.
What is done in hypospadias surgery?
The main purpose is to bring the urinary hole called the urethra to the tip of the penis. The common question asked is; is the treatment performed with a stitch or a patch. Both methods are used. Basically, after creating the urinary canal with a stitch, bringing a patch on it as a layer will make the tissue stronger.
The curvature of the penis must be corrected.
Circumcision can also be performed together according to the weight status of the hypospadias. Or the foreskin can be used as a patch. However, the opinion expressed by some of our colleagues that surgery and circumcision should not be performed together is not correct. On the contrary, circumcision along with it will save the child from a second operation.
What does the Baby-Child and the Family expect after the operation? How long does he stay in the hospital? Will the probe get stuck?
Currently, pediatric urology specialists or pediatric surgeons who are experienced in hypospadias perform hypospadias surgeries as daily surgical procedures. So the child gets an operation and can go home the same day. The dressing is opened on the third or fifth day after surgery. On the seventh day, the probe is withdrawn. there is no need to stay in the hospital.
Urinary probes, called stents, are necessary for healing. Babies can be sent home with the probe using a double cloth. In older children, the stent is cut off immediately near the head of the penis, the child can go to the toilet by himself and urinate from the stent.
What are the complications?
As I mentioned above, the complication rate is very high in inexperienced hands. The child or baby should be given the chance to solve this problem with a single operation. The success rate of a penis that has been surgically treated before is less than one that has never been touched.
The most common complication is the development of a fistula; the urinary hole moves to the tip of the penis, but somewhere in between, urine comes from more than one hole due to the opening of the stitches. Decapitation is the most common complication. After the development of this complication, no intervention can be made before 6 months. However, it is also one of the easiest complications to fix.
Complete Decongestion of sutures, bleeding, gangrene development on the skin of the penis can be counted among other complications.
Stenosis and curvature of the penis are other important complications.
