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Hypospadias without hypospadias in a child. What is it, photos, forms

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Content

  1. Definition of hypospadias without hypospadias (notochord-type hypospadias)
  2. Reasons for development
  3. Signs
  4. Diagnostics
  5. Features and tactics of treatment
  6. At what age is it better to have the operation, what technique is used
  7. Preparing for surgery
  8. Duration and complexity of the intervention
  9. Recovery and care
  10. Possible consequences
  11. Chord-type hypospadias treatment cost
  12. Hypospadias Videos

Hypospadias without hypospadias (chord-like) is a congenital penile pathology, which negatively affects the functions of the excretory system. This disease is diagnosed in boys in the first hours after their birth. A child with a similar diagnosis has signs of underdevelopment of the penis and urethral canal. The severity of hypospadias without hypospadias is determined by the urologist or surgeon, depending on the deformation changes in the structure of the boy's penis.

Definition of hypospadias without hypospadias (notochord-type hypospadias)

Hypospadias without hypospadias is a shortening of the urethra with simultaneous curvature of the penis. The presence of this pathology occurs in every 150th male child. A distinctive feature of chord-type hypospadias is that the patient's penis is deformed downward.

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In this case, the child's urethral canal is in a taut state all the time. This is due to its abnormally short length. During an erection, the urethra compresses the corpora cavernosa of the penis, creating additional stress on the structural elements of the penis.

In urological practice, there are cases when congenital hypospadias has full patency, or is accompanied by simultaneous dysplasia of the urethral canal. Chord-type hypospadias are characterized by the presence of embryonic scars that disrupt the physiological functions of the epithelial tissues of the penis.

Hypospadias without hypospadias in a child. What is it, photos, forms
Hypospadias without hypospadias in a child

The presence of these formations enhances the deformation factor of the corpora cavernosa. The danger of hypospadias without hypospadias is the slow progression of the disease. In the neonatal period, as well as in boys under the age of 12, the chord-type curvature of the penis remains stable. With the onset of the puberty phase, an increase in pathological signs is possible with the development of even greater deformity of the penis.

Reasons for development

Hypospadias without hypospadias in a child is a congenital pathology of the penis, which develops under the influence of one or several negative factors at once.

In most cases, this defect of the male urinary system is provoked by the following reasons:

  • hereditary predisposition, when notochord-type hypospadias is transmitted to a newborn child on the paternal side along with genetic information;
  • the consequences of drug, alcohol and nicotine addiction in the mother of the child;
  • intoxication of the fetus with chemical and biological poisons at the stage of intrauterine development;
  • hormonal disorders in the body of the child's mother during pregnancy.

The most common cause of notochordic hypospadias is negative paternal inheritance. Consequences of intoxication of the body of a pregnant woman, pathological addictions, diseases endocrine system can provoke in a child not only hypospadias, but also other congenital defects development.

Cases of hypospadias without hypospadias are quite common in children born to a mother over 40 years of age. Boys conceived with the use of IVF reproductive technology are also at risk of acquiring this malformation of the genitourinary system.

Signs

Hypospadias without hypospadias has the following distinctive symptoms, which are determined visually by a pediatric urologist or surgeon during the examination of the child's genitals:

  • abnormally short urethra;
  • curvature of the penis downward, when the opening of the urethra remains in a normal position;
  • the urethra is in a taut state all the time according to the principle of a bowstring;
  • during an erection, the deformation of the penis becomes even more pronounced;
  • the urethra compresses the corpora cavernosa of the penis.Hypospadias without hypospadias in a child. What is it, photos, forms

In especially severe cases, a sick child has signs of narrowing of the walls of the urethra. In a similar clinical situation, chord-type hypospadias creates a cosmetic defect, and also disrupts the normal functioning of the urinary canal, kidneys, and slows down the process of urine outflow.

Diagnostics

Hypospadias without hypospadias in a child is diagnosed during a visual examination of the boy's external genitalia.

The doctor conducting the examination draws attention to the following signs of a congenital malformation of the genitourinary system:

  • the size of the child's penis;
  • the shape of the penis;
  • the position of the penis at the time of erection (whether the symptom of curvature downward is confirmed);
  • the length of the urethra;
  • the presence or absence of cicatricial changes in epithelial tissues in the urethra;
  • displacement of the urethra down the glans penis;
  • narrowing of the walls of the urethra.

Depending on the severity of chord-type hypospadias, a pediatric urologist or surgeon may prescribe the child to undergo an additional examination using ultrasound or MRI diagnostics. In this case, a study of the patient's bladder and kidneys is carried out for pathological changes in the tissues due to a violation of the outflow of urine. Without fail, the child donates blood from a finger and morning urine for clinical and biochemical analysis for quality indicators.

Features and tactics of treatment

Hypospadias without hypospadias in a child is treated only with surgery. The sooner the surgical intervention is performed, the less the likelihood of developing pathological complications.Hypospadias without hypospadias in a child. What is it, photos, forms

The table below describes the features of the tactics for the treatment of chord-type hypospadias.

Features of surgical treatment Tactics of the therapeutic process
Chord-type surgical therapy for hypospadias can be performed in 2 stages In this case, a pediatric surgeon draws up an individual treatment plan for a child with signs of deformational changes in the urethra and penile tissues. The first step is to correct the length and width of the urethra. At the next stage of the therapeutic process, the doctor corrects the position of the penis, eliminating the signs of its curvature downward. The terms of treatment depend on the severity of the pathology, but on average it lasts from 1 to 2 years. This approach allows you to achieve complete tissue healing, and also minimizes the risk of postoperative complications.
Restoration of the normal length of the urethra Formation of a physiologically correct urethra is one of the main tasks in the surgical treatment of chordal hypospadias. To achieve a positive effect, plastic surgery of the urethra is performed using epithelial tissue flaps, restoration of the missing portions of the penis.
Prevention of postoperative complications Chord-type hypospadias treatment is a multi-stage and lengthy process. The period of recovery of the operated tissues is no less difficult. Particular attention is paid to the factor of infectious inflammation of the urethral canal and foreskin. To prevent these complications, the patient undergoes an intensive course of therapy with antibacterial drugs, the pharmacological properties of which extend to the organs of the urogenital tract.
Normalization of urine outflow Children with hypospadias without hypospadias, which is accompanied by pathological narrowing of the urethra, are shown to restore its full flow capacity. For this, the walls of the urethra are expanded using surgical instruments. In the postoperative period, the surgeon ensures a stable drainage of urine from the cavity of the urinary canal using a catheter. After the healing of the operated tissues, the child returns to the previous way of life, the risk of delay in urine outflow is eliminated.

A feature of the surgical treatment of hypospadias by the chord type is the simultaneous elimination of a cosmetic defect in the part curvature of the penis downward, as well as restoration of normal length and width of the urethra child.

At what age is it better to have the operation, what technique is used

It has been scientifically proven that surgical treatment of hypospadias without hypospadias is most successful when performed when the child is between 6 and 18 months of age.

The pediatric surgeon manages to simultaneously achieve the following quality results:

  • eliminate the factor of psychological stress (children of the younger age group emotionally tolerate surgery much easier);
  • to prevent the occurrence of concomitant complications in the organs of the excretory system;
  • provide faster recovery of the operated tissues;
  • prevent the development of degenerative changes in the structure of the penis.

Hypospadias without hypospadias in a child. What is it, photos, formsA child with notochordic hypospadias, who was operated on in early childhood, receives healthy genitals with anatomically correct urethra. It is especially important that all stages of the surgical treatment of this malformation are completed before the time when the child goes to kindergarten or general education school. This will relieve him of psychological complexes and feelings of his own inferiority.

Preparing for surgery

Hypospadias without hypospadias in a child is treated only with surgery.

Preparing for surgery involves observing the following rules:

  • Re-examination of the child by a pediatric urologist 2-3 days before the scheduled date of surgery.
  • Hospitalization of the patient in the hospital of the surgical department of the hospital 1-2 days before the operation.
  • Refusal to take medications that thin the blood. The attending physician should be advised of what medications the child is taking.

Preparation for surgical treatment of chord-type hypospadias requires a mandatory diagnostic examination with the delivery of the following tests:

  • coagulogram;
  • determination of the blood group and rhesus factor (if this information is not available in the child's medical record);
  • ECG with a transcript of a pediatric cardiologist;
  • analysis of venous blood to determine antibodies to the hepatitis C virus, HIV, the causative agent of syphilis;
  • study of feces for eggs and larvae of helminths;
  • analysis for enterobiasis.

In the process of preparing for surgical treatment, the child must pass a general urine test and capillary blood from the ring finger bundles to perform a clinical study. Based on the results of laboratory examination, the urologist decides on a possible surgical intervention.

Duration and complexity of the intervention

Surgical treatment of hypospadias without hypospadias is a complex therapeutic procedure that is carried out in several stages. The operation is performed under sterile conditions in the urology department of the hospital. The child is under general anesthesia. The duration of reconstructive plastic manipulations depends on the complexity of the clinical case. On average, one operation lasts at least 3-4 hours.

The table below shows the goals of chordal hypospadias surgery, which reflect the complexity of the surgery.Hypospadias without hypospadias in a child. What is it, photos, forms

Surgical Therapy Objectives Complexity of the operation
Penis tissue correction Plastic correction of the penile tissue is considered a complex therapeutic procedure. The essence of this type of surgical manipulation is to correct the corpora cavernosa of the penis, which have signs of pronounced curvature.
Formation of the urethra The creation of a new urethra with its lengthening and lateral expansion is one of the most difficult tasks in plastic urology. The surgeon forms a new urethra for the child, which was not formed in a timely manner at the stage of intrauterine development. The urethra, formed by the urologist, continues to grow as the child develops. Achievement of this result indicates that the surgical operation for plastic urethra, elimination of signs of its shortened state, was successful.
Physiologically correct positioning of the urethral canal The final stage of urethral plastic surgery is the insertion of the urethral inlet into the apex of the child's penis. After the completion of surgical procedures, healing of the operated tissues, the patient must independently urinate with an even stream of urine without signs of splashing to the sides. This stage of treatment for a child is considered less difficult than the correction of the corpora cavernosa of the penis, as well as the formation of the missing portion of the urethra.
Elimination of cosmetic defects After performing the main therapeutic actions aimed at surgical reconstruction of the urogenital defect of hypospadias by the chord type, the attending physician eliminates the postoperative defects. This is the final stage of treatment, which in 98% of cases is completed successfully without complications and negative consequences.

In the periods between the next surgical interventions, the child undergoes periodic examinations by a pediatric urologist. The doctor assesses the dynamics of the recovery of the operated tissues of the boy, they are timely warned inflammatory and infectious processes, the formation of fistulous canals in the urethra channel.

In the first days after the planned surgery, the child is in the hospital of the urological department, where he receives wound healing, antibacterial and anti-inflammatory therapy.

In the postoperative period, the outflow of the patient's urine is ensured by means of catheterization. In especially severe cases, it is possible to apply a cytostomy for a period of 7-14 days. Depending on the results of the treatment, the urologist may prescribe the urethral bougienage for the child.Hypospadias without hypospadias in a child. What is it, photos, forms

It is a surgical procedure that further expands the lumen of the urethra. The main disadvantage of this method of therapy is considered to be a high probability of developing complications in the form local inflammation of the walls of the urethra, as well as long recovery times of the injured mucosa shell.

Recovery and care

The length of stay of a child in the hospital of the urological department depends on the severity of the clinical case, the state of the patient's immune system, and the skill of the surgeon. In the postoperative period, the boy should be under the supervision of medical personnel for at least 6-12 hours. In especially difficult cases, the patient remains in the hospital for several days.

For faster recovery and prevention of complications, the operated child should receive the following care:

  • the wound on the genital organ is kept completely clean;
  • processing of the postoperative suture on the surface of the penis is performed 1-2 times a day, depending on the recommendations of the attending physician;
  • the operated tissues are daily lubricated with anti-inflammatory and antibacterial ointments (a prescription for the purchase of drugs in this category is written by a doctor);
  • the child visits the office of a pediatric urologist or surgeon for antiseptic treatment of the catheter or cystostomy, using which ensures the outflow of urine (the schedule of routine examinations by a doctor, dressings, is compiled individually for each patient).

Failure to comply with the basic rules of personal hygiene, lack of timely change of the child's underwear, ignoring the instructions of the attending physician entail the development of complications. In this case, the results of the painstaking work of the surgeon can be canceled out by the violation of the norms for the care of the postoperative suture.

Possible consequences

Surgical treatment of chordal hypospadias is successful in 75-95% of cases. After the tissues have healed, the child receives a fully functional penis without signs of physiological and cosmetic defects. Early correction of hypospadias without hypospadias allows achieving the effect of normal urination, eliminating the deformation of the penis.

A medical error, violation of the rules of postoperative care can cause the development of the following negative consequences:

  • inflammation of the operated urethra;
  • the formation of fistulous passages in the urethra;
  • infectious infection of the child's genitourinary system;
  • pathological narrowing of the urethra after bougienage or its additional lengthening using plastic surgery techniques;
  • rejection of epithelial tissues that have undergone surgery;
  • suppuration of individual sections of the genital organ;
  • splashing urine to the sides, or leaking along the lower part of the penis and hitting the surface of the scrotum (this complication occurs in children who have incorrectly formed the missing part of the urinary channel).

Children with signs of postoperative complications are hospitalized in the hospital of the urological department or receive medical assistance on an outpatient basis.

To eliminate the negative consequences of surgical treatment, antibacterial, anti-inflammatory, wound healing medicines are used. In critical situations, in the presence of signs of severe complications, suppuration, the development of an acute infectious and inflammatory process, it is possible to perform surgical debridement of damaged tissues.

Chord-type hypospadias treatment cost

The average cost of the entire course of surgical treatment of hypospadias without hypospadias is 93,000 rubles. This cost includes a preliminary examination of the child in the process of preparing him for surgery.

Hypospadias without hypospadias is a congenital urogenital malformation that affects the genitourinary system of boys. A child with this diagnosis has a too short urethra, compressed corpora cavernosa, curvature of the penis.

At the time of erection, the urethra is pulled even more, according to the bowstring principle. Early diagnosis and surgical treatment of chordal hypospadias ensures complete restoration of the anatomically correct shape of the child's penis. Therapy for this disease is carried out in 2-3 stages.

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