I. Definition of hypospadias
Urethral opening in any plane from the ventral side of the glans to the perineum, with abnormal distribution of foreskin “turban-like” accumulation on the dorsal side of the glans and ventral absence of the penis, often combined with ventral bending of the penis.
II. Epidemiology
The incidence of hypospadias is a common urological deformity in male children, with a prevalence of about 3.2% (1/300), with geographical and racial differences, and its incidence is also closely related to industrial development. 1997 MACDP and BDMP reported that the incidence of hypospadias increased from 2.02 per 1000 in 1970 to 3.97 per 1000 in 1993, with a significant increase in heavy hypospadias. The incidence of hypospadias increased from 0.11 per thousand in 1968 to 0.27 per thousand in 1990 and 0.55 per thousand in 1993.
III. Brief history of the development of surgical treatment
Galen (130-201, AD) was the first to use the term hypospadias to describe hypospadias. 1860 Bouisson was the first to use a transverse urethral plate to correct the hypospadias and reconstruct the urethra with scrotal tissue. 1874, the second stage of the hypospadias correction with Bouisson’s method was followed by a ventral flap of the penis to roll the tube and shape the urethra, i.e. Duplay surgery. In 1896, Hook designed an oblique foreskin flap with blood vessels to form the urethra, and in 1897, NoveJosserand attempted to repair hypospadias with a free foreskin rolled tube, and in 1900, Russell first attempted a one-stage hypospadias repair.
IV. Embryology of penile urethral development
At 4 weeks of gestation, the urethral groove begins in the urogenital sinus of the cloaca, the endoderm of the cloaca forms the urethral plate, and the urethral groove is formed by the urethral folds that rise from the urogenital sinus on both sides of the urethral plate to form the primary groove. The secondary sulcus is formed by the splitting of the head of the penis at 8 weeks of gestation. The number, morphology, and function of Leydig cells in the embryonic testis increase at 11 weeks of gestation, and the production of testosterone prompts the fusion of the urethral grooves in the ventral median to form the urethra.
The early embryonic penis is obviously curved ventrally, and the foreskin does not wrap around the penis, but runs obliquely from the urethral opening to the sides on the dorsal side of the glans, and at about 20 weeks of gestation with the completion of urethral fusion the foreskin also completes its wrapping around the glans.
V. Etiology
Simply put, it is the formation of hypospadias when the urethra is formed ventral to the penis and the urethral plate does not close completely. There are various factors that may be involved in this mechanism, such as endocrine disorders, genetic defects, environmental factors, etc. The theory of penile urethrogenesis stagnation has also been proposed, and the evidence is.
1. ectopic urethral opening ;
2, curvature of the penis ;
3, abnormalities in foreskin development, all resembling early manifestations of penile urethral development, but the mechanism of stagnation is unclear.
VI. Pathological changes
The basic pathological changes of hypospadias include.
1, ectopic urethra;
2.Abnormal distribution of foreskin;
3, penile curvature;
4, abnormal testicular development (dysplasia);
5, penile scrotal transposition and scrotal pair cleft.
VII. Diagnosis
The diagnosis of hypospadias is mostly based on Barcat’s typing method, that is, the position of the urethral orifice after correction by penile hypospadias is divided into distal type, middle type and proximal type. However, attention should be paid to the diagnosis of combined deformities of hypospadias: cryptorchidism, hiatal hernia and syringomyelia, chromosomal abnormalities, gender dysphoria, etc.
VIII. Preoperative evaluation and preparation
1.Determination of gender;
2.Radiological examination;
3.B ultrasound examination;
4.Pelvic exploration;
5.For those with dysplasia of external genitalia, hormone compensation treatment should be made.
IX. Cure standard of hypospadias
After complete correction of hypospadias, the opening of urethra is in the glans orthogonial position, the appearance of penis is close to normal, the function of urethral urination is good, and normal sexual life can be had in adulthood.
10.Contents of hypospadias repair
1.Correction of hypospadias;
2.Urethroplasty;
3.Urethroplasty and glansoplasty;
4.Phalloplasty (skin covering of the penis);
5.Phalloplasty.
XI. Other important factors for the success of hypospadias repair
1.Age of surgery;
2.Surgical instruments;
3.Surgical sutures;
4.Bleeding and hemostasis;
5.Surgical magnification;
6.Postoperative dressing and dressing;
7.Bladder spasm and analgesia, sedation;
8.Transfusion and urination.
XII. Choice of staged surgery
Severe hypospadias, accompanied by severe deficiency of reconstructive material.