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. 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 opening of the urethra is located on the ventral side of the body of the penis, 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 feet), with adhesions to the scrotal skin, and the penis cannot be cocked upward when erect, which is visible as an obvious bow when erect, often accompanied by a 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 (or turban-like), while the ventral side of the penis (foot direction) has less foreskin or is missing.
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, the incidence of hypospadias gradually increased.
Third, the harm of hypospadias?
The deformity of external genitalia and abnormal urination can easily be 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, 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.
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 Tubularized 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 technique 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.
1.The downward curvature of the penis is completely corrected and straightened.
2.The urethral opening is located at or near the tip of the penile head.
3.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 postoperative complications
1.Urinary fistula.
In other words, 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 surgery to repair the fistula.
2.Urethral stricture.
If the condition is serious and the treatment is not timely, it is necessary to remove the scarred stenosis section and reopen the urethroplasty if necessary.
3.Infection.
Infection can often cause insufficient blood supply to the reconstructed urethra and eventually lead to tissue necrosis, which can easily lead to stenosis or urinary fistula in the reconstructed urethra.
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 strictures 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), etc. In addition, it is relatively difficult to repair a urethral fistula at the coronal sulcus, and special attention should be paid to infection when repairing a urethral fistula (there are often more bacteria present in the distal urethra of the fistula, especially in larger fistulas where the distal urethra is not flushed enough with urine).
Ten, pre-operative tests need to be done
1. Gender confirmation.
Chromosome, ultrasonography, sex hormone examination (for adults).
2.Pre-operative routine examination.
Three routine, coagulation time, biochemistry, chest X-ray, electrocardiogram.
3.Pre-operative adjuvant therapy.
Psychological counseling; HCG (penile testicular dysplasia).
11.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 2 weeks after surgery 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.