Hypospadias is called malformations of the urethra area and the penis in males.
As a result of various disorders of fetal development is formed unusual location external urethral orifice - in the area of the glans penis to its root and even in the perineum.
Hypospadias can be combined with the body of the penis curvature, may be the splitting of the foreskin that covers the head of the pathological "apron." May be abrupt constriction (dysplasia) or urethral orifice (metatostenoz).
Causes
Hypospadias recorded with a rate of about one case per 1000 male births. In the vast majority of coronary and capitatum arises form the third most common - stem form, severe hypospadias have no more than 15% of all children with this pathology.
The exact cause has not been established yet, as put forward several theories of its origin. In general, preference is given:
- the effect of endocrine disruptors, which can be during pregnancy,
- Genetic abnormalities that cause the formation of a violation of the sexual area of a child,
- Pathology of early pregnancy,
- receiving medications, toxic substances.
According to research doctors children conceived by IVF, reveal more frequent formation of defects. But the direct connection with the process of artificial insemination not. Usually the problem is associated with the fact that this pregnancy was initially more severe.
Kinds
Depending on where the meatus (external urethral orifice) varies:
- capitatum hypospadias - a hole opens on the head, but not in the usual place, and below it,
- coronary form - hole located in the coronary sulcus area,
- stem - the orifice is opened in different places of the barrel member,
- Cod-stem (penoskrotalnaya) form - the duct is located in the transition zone of the penis into the scrotum,
- scrotal - duct opens into the scrotum,
- crotch - when the opening of the urethra opens on the perineum.
Photo: localization of various forms of hypospadias
symptoms of hypospadias
When capitate form
Conventional on-site location of the urethra opening is found only a special skin plate or a longitudinal groove which comes to the coronary sulcus.
Meatus are low, making it difficult to normal urination, strongly narrowed opening. The penis is bent seldom, and complaints can only occur with a sharp narrowing of the urethra. Normally, the curvature of the penis head comes with the growth and the start of sexual activity.
When the crown form
urethra located on the border of coronal sulcus. With this type can be quite pronounced curvature form the penis, it breaks down normal urination.
Baby urinates in a thin stream to the efforts, and the urine is always getting to his feet, and is required when emptying the bladder to lift up the penis. Untreated or improper treatment, this form may proceed in a more severe.
When stem hypospadias
meatus located at different levels of the penis, on the back surface thereof which faces the testes.
This disturbed normal urination while standing, urine stream is directed at the ground, the children can only urinate sitting on the pot or strongly rising up penis.
In addition, there is a curvature of the penis, it is deflected in the direction of a turn. The urethra is much narrower, particularly along the inside of the penis, creating obstacles to the jets of urine.
Cod-stem hypospadias
It appears similar to the previous form of the symptoms, but the urethral opening is located on the border of the urethra the scrotum. Urinate children is difficult, especially while standing, sitting, they are forced to write.
Scrotal form occurs most severely, since the urethra is split between the scrotum and penis while dramatically underdeveloped and curved.
The penis becomes similar to the clitoris, and the splitting of the scrotum can simulate the labia. Pee child can only sitting. Urine is irritating to the skin of the scrotum, which leads to inflammation.
Often there undescended testicles (cryptorchism), And if the defect is not repaired - the impossibility of further sexual activity.
perineal hypospadias
- the discovery of the orifice behind the scrotum, which is bifurcated. Penis size is very small, sharply curved, often it can be hidden scrotum. Often there is cryptorchidism. This form of complex correction as underdeveloped penis and his little plastic fabrics.
There is also a special form of hypospadias by the chord type. It characterized by underdeveloped and shorter urethra, which causes curvature of the penis downward, while the orifice is in its place. During erection penis bends short urethra as a bowstring.
Diagnostics
Capitatum, the crown and stem form does not represent difficulties in the diagnosis of the child already at the first examination. To clarify the status of the urethra is carried urofluometriyu, determining the rate of urination. If it decreases, conduct a detailed diagnosis of the whole urinary tract boy.
Difficult to diagnose scrotal and perineal hypospadias, especially if the penis is highly underdeveloped and no scrotum testicles boy may be mistaken for a girl, then you need to study the mandatory floor for karyotype and ultrasound examination of the genitals and urinary kidney bubble.
If doubts remain, MRI is performed to determine the exact position of the urethra, testicles and penis.
treatment of hypospadias
Hypospadias child brings a lot of inconvenience, including moral discomfort. Therefore, the defect correction is needed as soon as possible. Ideally, correct the defect in the first year of life, as the child will take the operation easier in the future to forget about it.
Operations carried out in one step at capitate, crown, stem front hypospadias. All other forms require a multi-step operations.
The main stages of operation are:
- the process of straightening the penis to give it a natural look and does not disturb the growth process.
- plastic urethra from the neighboring tissues, which do not have hair follicles, plastic head of the penis,
- removal duct of the urethra in its natural area with its plastic outer holes of the normal form,
- in severe forms of elimination of defects of the scrotum, possibly bringing down parallel to the testicles into the scrotum.
It is important to create the urethra so that the child was able to urinate normally. In addition, it is important, and the removal of cosmetic defects, as the child grows his genitals should not differ from the genitals of other children.
Prediction of complete cure hypospadias when the operation is timely to 95%. As the child grows the complexity of the operation increases and the percentage of the full treatment - decreases.
