I. What is hypospadias?
Hypospadias is one of the most common abnormalities of the pediatric genitourinary system, affecting approximately 1 in 250 newborns. There are generally 3 abnormalities in penile development.
1. Ectopic urethral opening: the opening is on the ventral side of the penis, proximal to the normal urethral opening to the pathway of the perineum. The closer the location of the urethral opening to the scrotum or perineum, the more severe the hypospadias.
2. Downward bending of the penis. The closer the position of the opening is to the glans, the lighter the degree of bending is generally, or even no bending. He Jianhua, Department of Pediatric Surgery, Affiliated Hospital of Ningbo University School of Medicine 3. Abnormal distribution of foreskin: the ventral foreskin of the head of the penis fails to fuse in the midline, and all the foreskin is concentrated in a cap-like accumulation on the dorsal side of the head of the penis.
Note: For severe hypospadias, especially in cases with cleft scrotum, preoperative chromosome examination and gonadal examination are necessary to confirm the gender to exclude hermaphroditism.
What are the causes of hypospadias? Is it possible that hypospadias can occur in a second child?
1. There is a family tendency to develop hypospadias, which may be related to various genetic factors.
2.It is related to the deficiency of gonadotropin.
3. In recent years, the incidence of hypospadias has increased due to environmental pollution and the extensive use of chemical fertilizers and growth promoters in crops.
4.The application of hormones that promote pregnancy or protect the fetus during the mother’s preconception and pregnancy also has an effect on the development of the fetal reproductive system.
What are the dangers of hypospadias?
Hypospadias is often accompanied by downward curvature of the penis or painful when the penis is erect. If left uncorrected, children with severe hypospadias need to urinate in a sitting position and avoid intimate contact with the opposite sex due to fear of sex.
IV. Is there fertility in hypospadias?
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. The existence of fertility in patients with hypospadias can only be determined by checking sperm in adulthood, where normal endocrine development is the key. There are now cases of marriage and childbirth among the patients with hypospadias that we treat.
V. What are the current treatment methods for hypospadias? Which children need surgical treatment?
Currently, surgery is the only and best treatment for hypospadias.
Except for a very small number of cases where the opening of the urethra is located at the head of the vagina and there are no obvious abnormalities in the shape of the penis, the head of the penis and the distribution of the foreskin, all the following urethra need to receive surgical treatment.
VI. When is the best time for surgical treatment?
The best age for surgery for hypospadias is 6~12 months, the penis develops rapidly within 6 months, and after 6 months the penis tends to stabilize, and the child’s tolerance for anesthesia improves significantly after 6 months, plus the child’s memory is not strong at this time, so the surgery has less impact on his psychological development, and there is no major obstacle to future sexual behavior if the penis looks normal. At this age, postoperative pain and catheter discomfort are mild, while the infant’s poor mobility makes postoperative care easier. We also found that the incidence of complications of urethroplasty for hypospadias was significantly higher in older children than in younger ones.
7. So what kind of results can I achieve after the surgery?
After the surgery, the following criteria can be achieved: 1) complete correction of hypospadias; 2) urethral opening at the tip of the penis head; 3) near normal appearance of the penis, ability to urinate standing up, and ability to have normal sexual life in adulthood.
VIII. What issues need to be noted after surgery?
Generally speaking, after surgery, the main issues that parents are most concerned about are incision pain care, incision dressing care and urine drainage care for the child. Here we will answer them one by one.
1.Incision pain problem: The penis is very painful after surgery because of the dense distribution of sensory nerves, so we give analgesic treatment. Commonly used methods include oral or intramuscular injection of painkillers, sedatives, and analgesic pumps, which can be administered continuously through a vein within 48 hours, with good results, so that the postoperative period is truly painless.
2, incision bandage problem: we routinely postoperative with special sponge bandage penis, not only to play the purpose of pressure to stop bleeding, but also not to affect the trauma blood supply. Generally, the sponge dressing is removed 5 days after surgery, and thereafter the trauma remains open until the catheter is removed, and the trauma does not require special treatment.
Urinary drainage: We use special urethra tubes for urethral support and urinary drainage after hypospadias surgery, which has the advantages of no cystostomy after surgery, fast recovery of the child after surgery, easy management and care, etc. Urethra tubes are usually removed 12~14 days after surgery.
What are the most common complications after hypospadias surgery?
1.Urethral fistula: it means that the urine is leaking during urination, which can be repaired surgically.
2.Urethral stricture: the urinary line is very thin and accompanied by difficulty in urination. It is often necessary to remove the narrowed urethra and recreate it.
3.Infection: Infection can often cause insufficient blood supply to the reconstructed urethra and eventually lead to tissue necrosis, resulting in narrowing of the reconstructed urethra or urinary fistula.
10. Is it easy to repair pediatric urinary leakage?
Generally speaking, the success rate of urethral fistula repair is higher than that of urethroplasty, for the simple reason that it is easier to repair a spot than a long section of urethra. However, there are some special cases where urethral fistula repair is often unsuccessful, such as when there is a stricture at the distal end of the fistula, severe scarring at the fistula, a long segment of the urethra splitting (called a 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 fistula (often there are more bacteria in the distal urethra of the fistula, especially in larger fistulas where there is not enough urine flushing). Overall, the success rate of urethral surgery should be higher in specialist hospitals and with specialist surgeons.
XI. Where can I get the most professional and best technology to treat hypospadias?
Hypospadias surgery is strictly speaking a plastic surgery. The surgical precision is high and the actual operation is difficult. Even in developed countries, there are various post-operative complications. Choosing an experienced specialist to perform the surgery, usually a pediatric urologist specializing in pediatric urology, is the first step towards success.