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Characteristics of hypospadias, the causes of its development, methods of diagnosis and treatment

Hypospadias of the penis ‒ pathology, the reason is ‒ congenital malformations of the genitourinary system, this condition is characterized by the absence of cut on the lower wall of the urethra. The outer hole it can "descend" into the lower part of the penis closest to the scrotum or even the perineum.

Patients with pathology 2 and 3 degrees life is complicated, the process of urination, they may only be browsing, but even when the urine gets to the scrotum, underwear, inner thighs. Sexual intercourse also occurs with severe obstruction, as a malformation of the urethra is attended with curvature of the penis.

Sometimes there is narrowing of the opening of the urethra, leading to difficult bladder emptying. Hypospadias in children in grade 3 – this is the reason of the difficulty of determining the sex of a newborn child, because the penis resembles a hypertrophied clitoris, and the scrotum is cleft – pudendal lips.

Treatment 1 degree of hypospadias is not carried out, in other cases will require multi-stage surgical procedures that aimed not only to "return" the urethra in a normal position, but the straightening member. Surgical treatment should be carried out no later than 3-5 years of age, otherwise develops persistent (irreversible) deformation of the penis.

Types of anomalies (classification)

To distinguish the following degrees of hypospadias:

  • Capitate hypospadias (on the basis of the head of the penis).
  • Coronary (coronary sulcus).
  • Stem (shaft).
  • Scrotal (scrotum).
  • Perineal (the urethra opens in the perineum).

In the classification of the disease, there is another form of hypospadias without hypospadias (or type of chord) when the urethral canal in normal and abnormal development of affected cavernous body.

Etiological factors

Unfortunately, the exact cause of the defect, the child is still unknown. The only proven fact is the only pathology is congenital in nature and is manifested from the first days of life.

Factors that can indirectly affect the normal development of the embryo:

  • Change of pregnancy at 7-15 week, the reason for this is the impact on the fetus of harmful factors (unhealthy habits, medication, poor nutrition).
  • Sharp hormonal fluctuations in the body of the mother (causes severe congestion, stress).
  • Repetitive pregnancy.
  • Multiple pregnancy.
  • Genetic (hereditary) causes.
  • A variety of intrauterine infection.

Primarily a serious cause of hypospadias in a child is a severe infectious disease that lead to congenital deformities in newborns (toxoplasmosis, cytomegalovirus, AIDS,syphilis). Not recommended during pregnancy to work with chemicals (detergents, varnishes, paints, powders, etc.). Serious reason ‒ radiation and anti-TB drugs.

Usually, hypospadias is often hidden many congenital abnormalities. Now recorded over one hundred syndromes that accompany hypospadias. Any proven fact anomalies requires a strictly individual approach, as incorrectly assigned to the treatment may lead to psychological tragedies.

How to recognize a deformation?

Symptoms of strain when meatus located in the "wrong place" are visible almost immediately. At the initial examination by a doctor establishes the proper development of the genitals and urinary system of the boy in General. You may notice the following symptoms of hypospadias:

  • Symptoms of underdevelopment of the penis (curved, small thickness, almost complete fusion with the scrotum).
  • Difficulties with sex determination.
  • The symptoms of hypospadias, but with the absence of hypospadias.
  • Splashing during urination, discharge from meatus located in the wrong anatomical location.

Symptoms properly positioned meatus immediately noticeable, and they, as a rule, join a few of the symptoms related to diseases or deformities of the genitourinary system.

The only clinical symptom on which the diagnosis is the location of meatus. At the most mild, when the external opening of the urethra is slightly lowered below the position vector, symptoms may be unnoticeable until the time of puberty of the boy.

Related article: Androgyny — signs and treatments

It is difficult to notice the symptoms when meatus located on the trunk or in the scrotum. Since the mucous membrane in such a place is absent, the urine, constantly getting on the skin, it causes irritation. This is especially problematic in the neonatal period when the baby wets the diaper and the parents redness mistaken for a simple diaper rash.

The older boy is aware of the problem and are usually able to urinate so that the irritation did not arise. But amid the sexual development, when they have the need for intimate life, develop symptoms of psychological disorders, so as to carry out normal sexual intercourse for a young person problematic.

Poterpevshie events

Diagnosis of hypospadias is a simple task and almost 90% of newborn pathology is diagnosed in the first days of life, as the symptoms are pronounced.

Diagnosis significantly difficult due to the lack of testicles (testicle) that (which) is notdropped (not dropped) to a "sack". In this case, as advanced diagnostics will need to use a karyotype and have an ultrasound in difficult cases, MRI, cytoscopy and diagnostic laparoscopy (the price of each individual survey).

In General, diagnosis is the following:

  • Inspection of the external genitalia.
  • The location of meatus (meatus).
  • The establishment, where stands out the urine (typical or abnormal).
  • Determination of character of urine flow.
  • Hypospadias in children sometimes requires the study of chromosomes (sex chromatin) when the sex of the baby is difficult to establish visually.
  • Diagnosis using an ultrasound to rule out any deformities in the area of the kidneys and urinary tract.
  • Diagnosis using cystourethrography.
  • Diagnosed by intravenous urography.

Diagnosis of hypospadias requires a thorough examination by a doctor-a neonatologist, and because this Vice is always accompanied by a multitude of genetic abnormalities, the need and the consultation of the doctor-genetics.

Basic therapeutic interventions

Is it possible to get rid of hypospadias? It all depends on her degree. Capitate hypospadias will require a minimum of surgical interventions and corrective plasty's own tissues.

In Russia use a multi-stage surgical correction, which is carried out first, straightening of the shaft of the penis with creation of a supply of leather. Next, you need to create a normal urethra. The terms "downtime" between these two surgical interventions are sometimes calculated for months or even years. Given that there are often complications at the first stage, sometimes to the penis to function in a more or less acceptable mode requires at least 15-25 stages of surgical treatment.

The main ways of treatment:

  • Surgical treatment. Carry out the restoration of the typical position of the external urethral canal (sometimes mounted stent). If necessary, surgery is required to straighten the member.
  • Age criteria for treatment. It is believed that the optimal age to correct the hypospadias is between 6 and 15 months, and, the sooner the operation the better. If required re-intervention, that could be done in 6-7 months.
  • The completion of the treatment. Any correction must be completed by school age, 10-13 years after treatment results are much worse.

To establish normal urine flow, sometimes mounted stent (stenting of the urethra). But not all experts think the stent is the only option, as it tends to become infected, overgrown fibrous tissue and becomes a source of strongof the inflammatory process.