Hypospadias is one of the urinary system anomalies seen in boys. This situation is experienced in one out of every 250 boys under the influence of genetic and hormonal factors. This situation is defined as the circumcision of the prophet or half-circumcision among the people.
How does hypospadias develop?
The reason for the development of this condition, which is also called half circumcision, is not known exactly, but it is thought that the baby develops with the effects of genetics, hormonal and environmental factors during its development in the mother's womb. During development, the baby's urethra runs along the penis and extends to the tip of the penis. Due to the disruptions experienced during this period, the elongation is not fully complete and the opening of urethra stops before it reaches the tip of the penis. Even if the baby's penis development is not complete, the foreskin in this part also does not develop and the situation called half circumcised occurs.
How Is Hypospadias Diagnosed?
Hypospadias is easily diagnosed, usually at the first examination after birth. It manifests itself as the absence of the anterior part of the foreskin of the baby, the urethra not being at the tip of the penis, but even lower, and in some cases, being on the curvature of the penis. However, in some cases, even if the urethra is lower, the foreskin develops normally, so this is evident during circumcision when the foreskin is pulled down. In this case, circumcision is not performed and surgical procedure is applied instead. In some rare cases, the urethra may be much lower, the curvature of the penis may be severe, and the penis length may be small. In this case, it may be difficult to determine the gender of the baby and additional examinations may be performed.
Types of Hypospadias
Hypospadias disease, which is defined as being born half circumcised, is divided into several types according to the level of the urinary opening. It is defined as mild hypospadias if the urethra is close to the tip of the penis, moderate if it is in the middle parts, and severe if it is towards the root of the penis or below. Mild to moderate severity is seen in the vast majority of children. In addition, with the aggravation of the condition, the incidence of accompanying diseases such as undescended testis and inguinal hernia increases. Mild and moderately severe conditions are not accompanied by an additional disease, and the treatment of these conditions can be performed with a single-stage surgery.
Surgery is the only treatment available for hypospadias. The operations are performed under general anesthesia and with this procedure, if there is curvature in the penis, it is corrected and the urethra is extended to the tip of the penis. The deformity of the glans penis is turned into a normal conical shape. During the procedure, a silicone catheter is used to protect the newly opened urinary tract and to create a mold. Post-operative dressings are opened between 3 and 5 days and removed completely after 7 days. However, these periods may differ depending on the patient's condition.
When is Hypospadias Surgery Applied?
The surgical procedure is preferred in babies between 6 and 18 months of age. Before 6 months, anesthesia is risky for the baby and penis size is too small. In addition, do due to accelerated development of sexual identity in children between the ages of 2 and 6 years, the procedures performed during these periods may affect the child psychologically and therefore are not recommended for children in this age range.
What Happens If Hypospadias Is Not Treated?
If hypospadias disease is in advanced stages, it can cause some problems. Especially in children who start to urinate standing up, sitting down may be required to pee. Along with this, psychological problems are also seen in children. In cases where treatment is neglected, the possibility of the child having sexual problems in the future is also high.
Is Circumcision Objectionable Before Hypospadias Surgery?
In children with this condition, the foreskin does not develop from the front of the penis, but the foreskin is located at the back. Since this foreskin is used in surgery in some cases, it is necessary to perform circumcision beforehand. In addition, according to the findings during circumcision, the procedure should be continued in line with the age of the child and the expertise of the surgeon performing the procedure.
Some complications may occur in the early and late postoperative period. Edema, bleeding, infection are complications that can be seen in the early period. In the late period, conditions such as wound opening, urethrocutaneous fistula, stenosis and diverticulum can be seen. The improvement in appearance after hypospadias is seen after 6-12 months.