Hypospadias is a common congenital external genital anomaly in urology. It has a high incidence and is one of the more common pediatric diseases seen in our department. Our department is at the forefront of the treatment of congenital hypospadias in China. In addition to the patented penile head perforator, we have also taken the lead in introducing advanced surgical techniques from abroad, and have treated many cases of hypospadias with high difficulty and few postoperative complications. The following answers are given to the more frequently asked questions by patients in the clinic, in the hope that patients and their families can further understand the disease.
I. What is hypospadias?
1, urethral opening ectopic: This is a typical feature of hypospadias, the opening in normal people is at the front of the head of the penis, while the urethral opening in patients with hypospadias is located on the ventral side of the penis body, or in severe cases, in the scrotum or perineum (often squatting to urinate).
2, penis downward bending: penis downward (foot direction) bending, there are adhesions with the scrotal skin, erection of the penis can not be upward, visible erection obvious bow, often accompanied by penis development than the same age short.
3, abnormal distribution of foreskin: typically seen in the dorsal side of the penis (head direction) excessive accumulation of foreskin, hat-like (or turban-like), while the ventral side of the penis (foot direction) is less foreskin or lack of such.
Second, the cause of the formation of hypospadias?
1.Urethral hypospadias is a congenital disease and may be related to a variety of genetic factors.
2. Insufficient production of hormones such as testosterone or abnormal process of conversion to dihydrotestosterone during the mother’s pregnancy
3.The mother applies hormones for pregnancy promotion or fetus preservation before and during pregnancy.
4, environmental and food pollution Living environment chemical pollution and food pollution, such as plasticizers, etc., the incidence of hypospadias gradually increased.
Third, the harm of hypospadias?
The deformity of the external genitalia and abnormal urination are easily ridiculed by peers, which has a serious impact on the physiology and psychology of the affected children. In adulthood, the penis is not corrected in time due to the bending of the penis, the penis is mostly stunted and short. Not confident about sexual life or even fear and avoid intimate contact with the opposite sex. And cause parental tension and anxiety, bringing a huge psychological shadow to the family.
Fourth, whether it affects fertility?
The fertility of a person depends on the number of sperm produced and the quality of sperm, only a certain number of normal sperm will conceive and give birth. Patients with hypospadias can only determine the presence of fertility by checking sperm in adulthood, and normal development of endocrine is the key. Normal fertility can be restored in moderate to severe hypospadias after correction.
V. The best time for surgery
The best age for surgery for hypospadias is 2 years old to preschool age. Scholars at home and abroad have reported that there is no significant difference in the difficulty of surgery between children over 2 years of age and adults, and that children’s tolerance to anesthesia is significantly higher after 2 years of age, their memory is not strong, and the surgery has the least psychological impact on them. At the same time, children have the advantages of faster postoperative recovery, easier care and fewer complications such as infection compared with adults.
What are the treatment methods for hypospadias?
Surgery is the only treatment method for hypospadias. In 1994, Snodgrass first reported the preservation of urethral plate longitudinal incised plate urethroplasty (TIP), which has become the most popular urological procedure because of its high success rate and easy operation. It has become a mainstream procedure in Europe and the United States because of its high success rate and ease of operation. Recently, this procedure has been widely reported in China. Our department has been the first to introduce this technique in China, and has achieved satisfactory results and published a lot of papers on this procedure.
VII. What can be achieved after surgery?
After the surgery, the following standards can be achieved: complete correction and straightening of the downward curvature of the penis. The urethral opening is located at or near the tip of the penile head. The appearance of the penis is close to normal, and it can stand to urinate and have a normal sexual life in adulthood.
VIII. Common post-operative complications
1. Urethral fistula: In addition to the normal urination of the formed urethral orifice during urination, an abnormal fistula appears on the ventral side of the penis and urine is discharged, which requires another operation to repair the fistula.
2, urethral stricture: postoperative urinary line gradually thinning and accompanied by difficulty in urination, need to be early intervention, if the condition is serious, treatment is not timely, if necessary, need to remove the scar stenosis section, re-urethroplasty.
3. Infection: Infection can often cause inadequate blood supply to the reconstructed urethra and eventually lead to tissue necrosis, which can easily lead to narrowing of the reconstructed urethra or urinary fistula.
IX. Treatment of complications?
Generally speaking, the success rate of urethral fistula repair is higher than that of urethroplasty, for the simple reason that it is more convenient to repair a spot than a long section of urethra. However, repair of urethral fistulas is often unsuccessful in some special cases, such as stenosis at the distal end of the fistula, severe scarring at the fistula, splitting of the long segment of the urethra (called urethral fistula by some surgeons), and so on. In addition, it is relatively difficult to repair a urethral fistula at the coronal sulcus, and special attention should be paid to the infection when repairing a urethral fistula (often there are more bacteria present in the distal urethra of the fistula, especially in larger fistulas where the distal urethra is not flushed enough with urine).
X. Pre-operative tests that need to be done
1, gender confirmation: chromosomes, ultrasound, sex hormone examination (adults).
2.Pre-operative routine examination: three major routine, coagulation time, biochemistry, chest X-ray, electrocardiogram.
3.Pre-operative auxiliary treatment: psychological counseling; HCG (penile testicular dysplasia).
XI. Hospitalization time
According to the patient’s condition to determine the mode of surgery, perform a phase of surgical treatment or staged surgical treatment. If the first stage patients need to be discharged after 2 weeks to observe urination, if normal, they can be discharged. Staged patients can be discharged from the hospital after 1 week and return to the hospital after 6 months to 1 year for further treatment.