Hypospadias: types, causes, treatment
Hypospadias are the most common clinical disorder in the urethra structure in male patients.Due to congenital disruption of the structure of the urethra, meatus urinarius( an external opening of the urethra) is located in an atypical place, ie, not on the head, but on the posterior surface of the penis or in the scrotum.
Over the past few decades, this pathology has been fixed with a frightening frequency.If half a century ago hypospadias in newborn boys met on average in one case out of 500, now it is observed four times more often( 1: 125)!Table of contents: Clinical signs of hypospadias Why does hypospadias develop?Concomitant diseases Classification Symptoms of the disease
Clinical signs of hypospadias
The main sign of hypospadias is the dystopia of the meatus( displacement of the urethral opening of the urethra in the proximal direction) with location in the scrotum, perineum, trunk or coronary sulcus of the penis.
The following symptoms can occur:
- more or less pronounced curvature of the cavernous bodies of the penis;
- dysplasia of the foreskin - cleavage with hanging in the form of a hood.
Important: , the degree of curvature is usually determined already in the course of surgery during the "artificial erection" test.
Why does hypospadias develop?
Etiology has not been sufficiently studied to the present day.
Among the leading predisposing factors, experts call:
- point gene mutations due to environmental degradation;
- hereditary predisposition( cases of birth of children with this pathology in several generations of the family are described);
- presence of disruptor compounds( androgen destroyers) in products consumed by a future mother;
- reception of hormonal preparations shown at threat of abortion;
- taking hormonal medications to prevent pregnancy less than a year before conception.
Note: for disruptors refers to substances that are used in the processing of edible plant crops( pesticides, fungicides and herbicides).They are able to have a negative impact on the intrauterine development of the child, in particular - on its hormonal status.
It is believed that with IVF( artificial insemination), the risk of a boy with hypospadias increases, as the expectant mother takes estrogens.
It is also possible that the stresses suffered by the mother during pregnancy, the lack of proteins in her diet, alcohol consumption, nicotine addiction, and the use of certain pharmacological drugs are not excluded.
Quite often, the anomaly of the development of the urethra is combined with one-or two-sided rejection of testicles in the scrotum, inguinal hernia, as well as pathologies such as urogenital sinus, reverse vesicoureteral urine reflux and hydronephrosis.
Due to the high likelihood of having parallel developmental pathologies of the excretory system in front of the planned surgical intervention, ultrasound is always performed.At detection of concomitant diseases, first of all their surgical treatment is shown and only then - urethra plastic.Children who do not palpate testicles or are diagnosed with microenia require consultation of endocrinology specialists.
In some cases, genetic research may also be required to establish a karyotype.This is necessary to identify the true( genetic) sex of the child.
According to the accepted classification, the following forms of pathology are determined:
- front( head and coronal form);
- mean( stem);
- posterior( scrotal or perineal);
- "hypospadias without hypospadias"( in the form of a chorda).
Symptoms of the disease
Symptoms of hypospadias largely depend on the form of the existing pathology
Symptoms of the head form of hypospadias
In this type of abnormality, the urethral meat is markedly displaced proximally in the direction of the coronal sulcus.Curvature of the cavernous bodies of the penis is usually not very pronounced, but the foreskin in the vast majority of observed cases is split.Patients complain of external defects and a thin stream when urinating.
Symptoms of hypospadias of coronary form
This form of hypospadia differs in the arrangement of the urethral opening directly in the coronary sulcus.A characteristic feature is the appearance of the foreskin: it has the form of a hood and is shifted to the dorsal surface of the penis.Patients complain of a narrowing of the orifice and problems during urination.
Stem( penile) hypospadias
The meat is located on the trunk of the penis( placement levels can be different).With this type of pathology, there is a pronounced change in the shape of the bodies of the penis, that is, their curvature.
Symptoms of scrotal hypospadias
The urethral meath is excreted on the scrotum.Often, not only the curvature is fixed, but also the abnormal location of the penis.The genitals of the patient have an external resemblance to the female genital organs.With this kind of pathology, consultation of the endocrinologist and genetics is absolutely necessary.
Signs of perineal hypospadias
This form is characterized by the placement of mechat in the perineum, cleavage of the scrotum and a pronounced violation of the structure of the cavernous bodies of the penis.Genitalia very often have a mixed structure, that is, there are features characteristic of both sexes.Often the question is raised about the true sex of the patient.
Hypospadias without hypospadias
The defect in the form of a chord differs from other variants of this congenital pathology by the normal anatomical position of the hole and the underdevelopment of the urethra itself.As a rule, the curvature of the penis is quite significant, but it is often due exclusively to a local disturbance in the structure of the skin.Often there is a presence of connective tissue strands along the urethra.
Treatment of hypospadias
Treatment of hypospadias involves surgical intervention in early childhood.The most suitable period for the reconstruction of the urethra and plasty of cavernous bodies is the period of the boy's life from a half-year-old age to 3-4 years.Most of the early operated children practically do not retain memories of the intervention, which minimizes the likelihood of psychological problems.
Objectives that pursue surgical intervention:
- Correction of the form of the corpus cavernosum of the penis;
- formation of the missing area of the urethra;
- displacement of the meate into the apex of the head of the penis;
- as much as possible complete elimination of cosmetic defects.
Important: successfully performed with hypospadias operation will allow the urethra after plasty to normally grow in parallel with surrounding tissues.The absence of cosmetic defects in the future will relieve a man of psychological problems associated with adaptation in society.
At present such operations are carried out in one stage;Modern methods of conducting them in more than 95% of cases allow achieving impeccable results, both from the physiology and from the side of cosmetics.
It is also very important that after a timely surgical treatment, patients in the future have no problems with erectile function and sexual intercourse.
More detailed information on the symptoms, causes of development and treatment of hypospadias in this video review is told by the surgeon:
Chumachenko Olga, pediatrician