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.
1.What is suburethral cleft?
(1) Ectopic urethral opening: This is a typical feature of hypospadias. In normal people, the opening is at the front of the head of the penis, while in patients with hypospadias, the urethral opening is located on the ventral side of the penis body, or in severe cases, on the scrotum or perineum (often squatting to urinate).
(2) Downward bending of the penis: The penis is bent downward (in the direction of the foot), there are adhesions with the scrotal skin, and the penis cannot rise upward when erect, and a bow shape is evident when erect, often accompanied by shorter penis development than that of the same age.
(3) Abnormal distribution of foreskin: Typically, excessive accumulation of foreskin is seen on the dorsal side of the penis (head direction) in the form of a cap-like (or turban-like), while the ventral side of the penis (foot direction) has less foreskin or is missing.
2.The reason for the formation of hypospadias?
(1) Hypospadias is a congenital disorder and may be related to a variety of genetic factors.
(2) Insufficient production of hormones such as testosterone during maternal pregnancy or abnormal conversion process to dihydrotestosterone
(3) The mother applies hormones to promote or protect pregnancy before and during pregnancy.
(4) Environmental and food pollution The incidence of hypospadias is gradually increasing due to chemical pollution of living environment and pollution of food, such as plasticizers.
3.The danger of hypospadias?
The deformity of external genitalia and abnormal urination can easily be ridiculed by peers, which can have a serious impact on the physiology and psychology of the affected children. In adulthood, the penis is not corrected in time because of 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.
4.Does it affect 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 existence 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.
5.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 for anesthesia is significantly higher after the age of 2, 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 to adults.
6.What are the treatment methods for hypospadias?
Surgery is the only treatment method for hypospadias. In 1994, Snodgrass first reported the preservation of the urethral plate longitudinal incised plate urethroplasty (TIP), which has become the most popular urological procedure because of its high success rate and ease of 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.
7.What effect can be achieved after the surgery?
After the surgery, the following standards can be achieved: 1. the penis is completely straightened by downward curvature. 2. the urethral opening is located at or near the tip of the penis head. 3. the appearance of the penis is close to normal, and it can stand to urinate and have normal sexual life in adulthood.
8.Common postoperative 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, and the fistula needs to be repaired by surgery.
(2) Urethral stricture: postoperative urinary line gradually becomes thinner and is accompanied by difficulty in urination, requiring early intervention.
(3) Infection: Infection can often cause insufficient 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.
9. 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 doctors), etc. 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 urethra, especially in larger urethra with insufficient urine flushing).
10. Pre-operative tests that need to be done
(1) Gender confirmation: chromosome, ultrasonography, sex hormone examination (for adults).
(2) Pre-operative routine examination: three major routine, coagulation time, biochemistry, chest X-ray, electrocardiogram.
(3) Pre-operative adjuvant therapy: psychological counseling; HCG (penile testicular dysplasia).
11.Discharge time
According to the patient’s condition to determine the mode of surgery, perform a phase I 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 after 1 week by removing the urinary catheter and return to the hospital after 6 months to 1 year for further treatment.