Hypospadias

Hypospadias: Description, Causes and Risk Factors:HypospadiasA developmental anomaly characterized by a defect on the ventral surface of the penis so that the urethral meatus is proximal to its normal glanular location; may be associated with chordee; also a similar defect in the female in which the urethra opens into the vagina.The urethra is the tube that urine flows through out of the bladder. It passes through the penis. The opening of the urethra (meatus or 'pee-hole') is normally at the end of the penis, partly covered by the foreskin.It is a condition in which the urethral opening does not form completely to the tip of the penis. Instead, the opening may be located anywhere along the underside of the penis. While the urethral opening is most often found near the head, a position referred to as distal, it also may be located from the middle of the penile shaft to the base of the penis or even behind the scrotum, positions called proximal. Over 80 percent of boys with this condition have distal hypospadias. In 15 percent of those cases, it is associated with mild downward curvature of the penis. In contrast, when the urethral opening is located more proximally, curvature occurs in more than 50 percent of patients.About 1 in 550 boys are born with some degree of hypospadias. It seems to be getting more common. The reason why the penis does not develop properly is still not clear. The development of the penis whilst the baby is growing in the womb is partly dependent on the male sex hormones such as testosterone. The effects of testosterone on the growing penis may be blocked in some way. Although it is not a genetic condition, hypospadias can run in some families.Symptoms:Passing urine is different to normal. However, when older, the urine stream may not be able to be directed forward into a urinal. When going to the toilet the urine is likely to 'spray' backwards.
  • Chordee which causes bending of the penis. This is more noticeable when the penis is erect.
  • Sexual intercourse may be difficult or impossible in severe cases.
  • Psychological problems about being 'different' to normal are common.
  • Mild erection difficulties and premature ejaculation have been reported in adulthood in some patients who have had surgery for hypospadias in childhood.
Diagnosis:The diagnosis is usually obvious from examining the penis. No other tests are routine. However, a small number of people with severe hypospadias (when the urethral opening is at the base of the scrotum) may have other abnormalities of the genitals. The appearance of severe hypospadias may be part of a rare intersexuality (intersex syndrome). Therefore, tests of the chromosomes and scans of the genitals may be made to determine if it is part of a wider syndrome.Treatment:If the hypospadias is mild, with the opening of the urethra just a little down from normal and with no bending of the penis, then no treatment may be needed. However, in most cases surgery is required to correct the hypospadias. This can usually be done in one operation. However, if the hypospadias is more complicated, then two or even more surgeries may be necessary.The goal of treatment is for urine to be passed in a forward way, for the penis to be straight when erect and for the penis to look as normal as possible. The position of the opening of the urethra is altered. Also, if chordee is present then this is corrected to allow the penis to straighten. The foreskin is usually used during the operation to make the new urethra.Hypospadias repair is usually accomplished in a ninety-minute (distal) to three-hour (proximal) same-day surgery. In a few instances, however, it is done in stages, usually when a pediatric urologist wants to separately straighten the shaft before constructing the urinary channel.The most common complication after surgery is the development of a hole — or fistula — from the urinary channel to the skin. Scarring within the channel or urethral opening also can occur, interfering with urination. In addition, the wound may fail to heal. If your child complains of urine leakage from a second opening or a slow urinary stream after hypospadias repair, he should see his pediatric urologist.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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