Hypospadias is a common congenital malformation of the lower urinary tract and external genitalia in males, resulting from an abnormal position of the urethral opening due to hypoplasia of the anterior urethra. The majority of cases occur in boys, but are rare in girls.
It is caused by the fusion of the urethral wall during the development of the urethra, resulting in the opening of the urethra in a different abnormal part of the ventral side of the penis, resulting in various types of clinical hypospadias. Hypospadias can be classified as penile head type, penile body type, penile scrotum type, and perineum type according to the location of the external urethral opening. The penile corporal type is the most common type in clinical practice. In addition, there are cases of simple hypospadias without hypospadias.
Children with hypospadias combined with undescended testes or hypogonadism often need to be differentiated from hermaphrodites.
Diagnostic points
1. Clinical manifestations
Hypospadias is a congenital external genital malformation, which can be easily detected, so there is no difficulty in diagnosis. The main manifestations are abnormal urethral opening, penile curvature and absence of apron-like foreskin and foreskin ties. The penile head type and penile body type usually do not prevent urination, and the penile curvature may not be obvious. In penile scrotal type and perineal type hypospadias, the penis is bent more severely, so it cannot stand up to urinate. In severe perineal hypospadias, the penis is short and the scrotum is divided and deflated like the labia, so it is often mistaken for a girl.
2.Auxiliary examination
(1) External genital examination to determine the location of the urethral opening for clinical typing, and gonadal examination to make sure the presence of bilateral testes and the scrotal descent.
(2) Differentiate children with perineal hypospadias complicated by cryptorchidism from hermaphroditism and female pseudohermaphroditism. For details, please refer to the section on hermaphroditism.
Treatment points]
Treatment of hypospadias is based on surgical reconstruction. The child’s urethral orifice is located at the head of the penis, the downward curvature of the penis is completely corrected, the appearance of the penis is satisfied and close to normal, and the child can urinate standing up and have a normal sexual life in adulthood. The age of surgery can be performed between 6 months and 18 months. The latest should not be later than 6 years old to avoid affecting the psychological development of the child.
There are various surgical methods for hypospadias, the purpose of which is to correct the curvature of the penis and reconstruct the urethra. Most of the operations can be performed in one stage, but in a few cases they can be staged.
The materials used to reconstruct the urethra are the ventral skin of the penis, the skin of the foreskin and scrotum with the tip, the free duct or the bladder mucosa. The surgical method may depend on the degree of hypospadias and the experience and condition of the operator.
1, simple penile hypospadias can be used to tighten the white membrane of the dorsal penis to correct the penile curvature, foreskin feasible plastic surgery.
2, the head of the penis type can be used urethral opening forward glansoplasty (MAGPI method), such as the head of the penis is obviously recurved can also be corrected in the dorsal side of the penis for white membrane tightening. The catheter will be left in place for 1 week after surgery.
3, the penile body type can choose the following one-time surgery with island flap urethroplasty (onlay island flap), Mathieu method, foreskin island tube urethroplasty (Duckett method); or staged surgery for penile recurvature correction (Nesbit surgery), 3-6 months after the second stage surgery penile ventral buried strip urethroplasty Surgery (Denis Browne method).
4, the penile scrotum type can choose the following primary urethroplasty Duckett method, or free bladder mucosal tube urethroplasty. Staged surgery (Nesbit ten Denis Browne method) is also available.
5, perineal type One-stage surgery can be performed by Duckett+ Duplay method. For penile dysplasia and severe penile curvature, staged surgery is recommended, with the first stage being followed by penile hypospadias correction (Nesbit surgery), followed by free bladder mucosal tube urethroplasty or Nesbit ten Denis Browne surgery after an interval of 6-12 months.
6.Urethral dilatation and urethral fistula repair Urethral stricture or urethral fistula formation can occur after urethroplasty. Urethral strictures can be dilated periodically after surgery depending on the degree of stricture. Smaller urethral fistulas can close on their own, but if they do not close after 3 months, urethral fistula repair is feasible.
7. If the penis is well developed without obvious penile recurvature, the Snodgrass method can be used for penile corporal urethral hypospadias.