Hypospadias is a malformation of the urethra, where the opening of the urethra opens on the underside of the penis, scrotum or perineum. This is the most frequent malformation of the urethra in boys. Its frequency is 1 in 150 newborn boys. In girls, this defect is extremely rare. In hypospadias the urethra is underdeveloped, and its length is reduced. Where there should be a tight urethra arises from the connective tissue scar (chord). Due to the fact that the channel length is smaller than normal, the penis is bent, prepuntsialny bag of undeveloped, open the glans penis, the skin of the foreskin does not cover it. Sometimes there is a shorter urethra, which opens in the usual place. In this case, the penis is bent in a hook, the curvature increases with an erection.
The diagnosis of hypospadias is exposed during normal inspection is in the hospital.
From the position of the urethra orifice are the following forms of hypospadias:
capitate form (the hole is at the head of the penis, but not in its usual place), capitate form of the most common, 65-75% of all cases of hypospadias, the urethral opening frequently shifted closer to the coronary groove
stem form (the hole is located on the lower surface of the penis), the degree of curvature in the stem form of hypospadias depends on the location of the urethral opening, than it is farther away from its normal location, the greater curvature of the penis. In this form of hypospadias, it may be associated with narrowing of the urethral opening
scrotal form (a hole in the scrotum)
perineal form (the opening of the urethra opens on the perineum).
Scrotal and perineal hypospadias forms are characterized by sharp curvature of the penis and decrease its size. External opening of the urethra can be greatly enhanced. The foreskin can be split. Sometimes this condition can cause difficulty in determining the sex of the child.
Treatment of hypospadias operative.
The most mild form of hypospadias - capitate. Often, when a small curvature of the penis does not require treatment. Be sure to surgery performed at narrowing the hole and the urethra with a significant curvature of the penis, where the sexual activity in the future may be difficult or impossible. In Russia, the optimal timing for surgical treatment is considered to be the child's age from two to five years. Overseas urologists operate on hypospadias at an earlier age, sometimes up to a year.
Surgery can be performed simultaneously or in two stages. The problem of surgical intervention: straightening of the penis and the missing area of plastic urethra. Straightening of the penis is achieved with excision of scar tissue (notochord) in place of an absent urethra. This allows you to create the conditions for normal development of the corpora cavernosa of the penis. If the operation is conducted in two phases, in this first phase ends. If surgery is carried out in one stage urethral plastic is held immediately. In a two-stage treatment, plastic surgery is performed in the preschool years. The material for the plastic missing part of the urethra serves as the skin of the penis, the skin of the foreskin, or scrotum. Occasionally, when the use of skin surrounding tissues can not be applied so-called free grafts (appendix - the appendix, part of the ureter, the site of the bladder mucosa).
Hypospadias in girls is rare. In this case the urethra is split along the back surface, split front wall of the vagina, the hymen is split. Opening of the urethra opens into the vagina. Usually, female hypospadias appears incontinence.
Treatment of hypospadias operative. Plastic surgery is performed to establish the urethra from the vaginal wall and the plastic bladder sphincter.