It is a congenital disorder seen in newborn boys. In a normal penis, the urethra (urethra) ends at the end of the penis head (glans) and the children urinate from the end of the penis.
In children with hypospadias, the urethra (urethra) ends on the lower face of the penis and ends behind. The urinary canal did not form at the distance between this end point and the tip of the penis.
The opening point of the urine can even be behind the testicles, and the further behind it, the more serious it is. However, the majority of cases are closer to the penis end.
WHAT’S THE SIGNS
1) Urine channel (urethra) on the underside of the penis
2) Flattening of the head of the penis
3) Prepusium not forming the lower part of the penis head (innate half circumcised)
4) Downward curvature of the penis when it comes to erection
S) Hypospadias children can not pee in the face of the opposite peeing to the right peeing This situation is required to pee in the sitting (instead of peeing on the feet).
6) Sexual function disorders may occur if the patients with urinary canal openings are not operated until adulthood.
Fetus (mothers’ womb) gender difference occurs during the first three months of the pregnancy and the development of the urinary tract stops and the hypospadias occur.
The cause of this developmental failure is not known. There are a number of inherited factors or any decrease in androgenic hormone stimulation.
The possibility of hypospadias in the infant who is expected to be born with a child with hypospadias is greater than 201% indicates the importance of hereditary causes.
Types of hypospadias according to the point where the urethra is opened
HOW IS DIAGNOSIS?
Nowadays, it is possible to make prenatal diagnosis by ultrasound during pregnancy. If this is not possible, it is easily diagnosed by clinical examination from the moment of birth. Rarely, prepusium in children with hypospadias can be normal and complete. In these cases, hypospadias near the tip may not be detected without scratching the foreskin backwards.
Approximately 300 men 1 at birth 300 are seen.
WHICH TESTS MUST BE MADE?
Another common congenital problem with hypospadias is unexplained testicular and inguinal hernia. Therefore, children with hypospadias should be checked for the presence of testicles and whether they have gone up and down.
Hypospadias cases may also occur as part of very rare gender differentiation problems (hermaphroditism). Therefore, sex discrimination tests (chromosome analysis etc.) should be performed in suspected cases.
Surgical surgery is the only treatment. In the operation, the fibrotic tape, which we call the chord which causes the penis to curl down, is cleaned and flattened so that the penis does not bend down when it comes to erection.
A new urine channel is created to complete the deficiency of the urinary canal to the end of the penis. The flattened penis head (glans) is given a natural conical shape. In other words, an aesthetically and functionally acceptable penis shape is created.
In the operation, very fine and sensitive techniques of Plastic, Reconstructive and Aesthetic Surgery are applied. In order for the surgical procedure to be successful, Plastic, Reconstructive and Aesthetic Surgery and especially with the capacity to have the knowledge and experience on this subject should be made by people.
There are different methods to be selected according to the type of hypospadias. The surgical procedure may take between 1 and 4 hours depending on the method chosen.
WHAT SHOULD BE MADE?
Since prepusium is used in many types of hypospadias to form an incomplete urine channel, this precious material should not be consumed by circumcision. So circumcision should not be done!
HOW DO I STAY IN THE HOSPITAL?
The length of hospital stay varies between 3-10 days according to the severity of hypospadias and the method applied.
HOW WILL THE SURGICAL RESULTS?
Following surgery, most children have normal function and a good cosmetic result. In 90% of children with hypospadias on average, problems are solved by a single operation. However, the complication and failure rate is greatly reduced when these operations are performed by non-qualified people who are not qualified by the Plastic Reconstructive and Aesthetic Surgery principles.
HOW IS THE REPRODUCTIVE FUNCTION?
If infertility is not another reason, such a problem is not expected in children with hypospadias. A successful operation does not have a negative effect in this direction.
DOES PSYCHOLOGICAL EFFECT?
Operations that are repeated and fail each time may affect the person psychologically. Therefore, a successful outcome at an appropriate age and with a single operation is always preferred.
WHAT IS OPTIMAL OPERATION AGE?
The opinions and practices in the world about operation age are different. Researches showed that after 18 months, the risk of negative effects on the child is high. Surgery before 6th month has a deterrent to the risk of general anesthesia. For these reasons and taking into account the developments in surgical techniques, it was preferred to be 2 to 3 years old, while the tendency to take this limit earlier was improved.
In summary, the optimal operation age is between 6 and 18 months.
It can be divided into two groups as early and late period. In the early period; complications such as bleeding, stitching, infection, etc. may be encountered in all operations.
In the late period, fistula (hole), stenosis (stenosis), downward flexion of the penis due to kordi recurrence and tendency to recurrent urinary tract infections may be observed.
Why is surgical correction of hypospadias necessary?
• Hypospadias is an anomaly that must be surgically treated.
• The boy may not usually have a standing pee as the hole of the Pipi is below; The girl needs to make her pee sitting down like children. This is an important problem for boys and can cause psychological problems.
• Due to the downward curvature of the piping, problems may occur during sexual intercourse in the following years. Because the penis can not be flat in erection; takes a similar shape to the comma.
Could there be any additional problems accompanying hypospadias?
• In some infants, additionally, eggs may not be in the bag.
• If eggs are not handled in advanced forms of hypospadias, additional problems related to gender development may arise. In such babies, chromosome analysis should be performed to ensure that no such problem exists.
• In advanced forms of hypospadias infants may have additional problems with urinary tract. For this reason, it is essential to have an ultrasound in the urinary tract.
What are the details of surgical intervention?
• The basis of the operation a) complete correction of the curvature of the tube b) the creation of a new additional urinary tract c) a new and wide urine hole and d) circumcision operation. It is also controlled by an ği artificial erection test an that is performed during the surgery, in which the curvature of the pin is fully corrected. For families who do not want circumcision, re-repair of the foreskin during surgery is possible.
• Hypospadias surgeries are generally daily interventions. The baby may be discharged from the hospital on the same day. In some cases, there may be a hospital stay for up to 1 night.
• The operation time is usually between 1.5 and 2.5 hours depending on the type and degree of the anomaly.
• After the surgery, the baby usually picks up a plastic probe for about a week. In some cases the probe can be held for up to two weeks. This is an important and necessary practice for the wound not to come into contact with urine and to facilitate recovery.
• Double diapers are used in infants after surgery. The probe is stretched out through a through opening in the first diaper and remains under the second diaper. Thus, without any bladder outside, the baby is easily transported on the lap and is able to move freely. The outer cloth is replaced with pee.
• The dressing does not open 1-2 days or may be opened later, depending on the physician’s preference.
• During this period of time, painkillers, syrups which prevent the bladder from contracting can be recommended. Usually, the use of antibiotics at a protective dose is recommended during the time the probe is left. In many hypospadias operations, an application is being performed to prolong the procedure. For this reason, the first 4-5 hours after the operation is much more comfortable and painless.
• After the catheter is removed, the child may pee through the pipette as usual.
Does the degree of penile curvature in the hypospadias and the hole being too low affect the operation and the technique to be applied?
Hypospadias is usually an anomaly that can be treated with a single operation. However, two-stage operations may also be required in cases where the penis curvature is too high and the piping hole is too low. In such cases, the pipeline curvature is corrected at the first attempt and the ground of the new urine tube is prepared. In the second attempt, a new urine channel is created and the pee-hole is moved to the tip of the pipette as usual.
If the size of the skin of the skin is such that it cannot meet all the requirements, additional tissue may be required from the mouth or from one of the hairless areas of the body. The parts taken from the mouth are preferred in terms of the fact that they do not leave any traces and the intra-oral wound heals spontaneously within a few days.
What are the post-operative problems?
The frequency of problems after mild hypospadias operations varies between 5-10%. The most common problem is the urine leak from the new urine, which we call ası fistula En. Another important problem is the shrinkage of the newly created piping hole and a small diameter of the pee. This problem can usually be managed without surgery. When the fistula is formed, the fistula hole is closed with a smaller intervention 6 months after the operation.
Postoperative problems in severe forms of hypospadias may be 15-20%.
As a result, when hypospadias is operated by appropriate individuals (pediatric urologist, pediatric surgeon trained in this field), a smooth, normal voiding is achieved. A normal sex life is possible in the future.
Performing surgery in the first year of life will prevent future psychological problems.
It is appropriate for mothers who are pregnant to take as much hormone-free foods as possible during their pregnancy and to be careful not to be present in areas with environmental pollution.