Hypospadias without hypospadias: how to recognize the disease, causes, treatment options
The department provides treatment for the entire spectrum of uroandrological pathology in children.
Modern, high-tech methods are used to diagnose and treat pathologies of the upper and lower urinary tract, such as hydronephrosis, megaureter, vesicoureteral reflux, urethral valves, bladder diverticula, solitary renal cysts and anomalies in the development of the urinary duct (urachus). In surgical treatment of hydronephrosis, the use of laparoscopic and minimally invasive techniques for plasty of the pyelourethral segment is a priority, and surgical treatment of hydronephrosis is carried out using retroperitoneoscopic access.
For endoscopic correction of vesicoureteral reflux in children, we use modern volume-forming preparations.
Minimally invasive laparoscopy - the use of special 3 mm trocars is used in the treatment of kidney cysts, urinary duct abnormalities and other pathologies of the urinary system.
Modern intraluminal endoscopy with stenting is used to correct megaureter, valves and urethral strictures.
Particular attention is paid to andrological pathology. Operations are performed for all forms of hypospadias, curvature of the penis, epispadias, strictures of the urethra, hidden penis, varicocele, inguinal hernias, traumatic injuries of the urethra, impaired sex formation, all forms of cryptorchidism.
Hypospadias treatment is carried out using modern methods of urethral plastic surgery, optical enlargement, and absorbable suture material. The priority is the use of one-stage methods of urethral plastic surgery. In the treatment of complex forms of hypospadias and urethral strictures, free flaps from the cheek mucosa (buccal plastic) are practiced. Together with endocrinologists, an examination and complex treatment of children with cryptorchidism, impaired sex formation and other related pathologies is carried out.
The treatment is carried out according to the latest techniques in the field of surgical treatment in children using modern technologies, equipment and materials: laparoscopy, intraluminal endoscopy, microsurgery, arthroplasty.
The applied methods of surgical treatment allow achieving optimal functional and cosmetic results, which ensures the quality of life of a small patient.
We provide medical assistance to citizens of the Russian Federation through compulsory medical insurance - compulsory medical insurance, VMP - high-tech medical care, VHI - voluntary medical insurance, paid services.
Specialists distinguish the following forms of this disease, due to the location of the urethral opening:
- Capitate variety - in the area of the base of the head of the organ,
- Coronary - located in the zone of the coronal groove,
- Stem hypospadias - observed on the trunk of an organ,
- Scrotum - opening on the scrotum,
- Perineal hypospadias - in the area of the perineum.
In addition to the above types of the disease, hypospadias without hypospadias is possible (type of chord) - in this situation, patients have a change in the corpora cavernosa in the presence of a normal location of the urethra exit.
Doctors attribute the capitate, coronary variety to anterior pathology, stem hypospadias - as a rule, the middle, perineal, scrotal - determine the rear view. Different types of the disease can be combined with the obstructive form of the urination process, organ deformation:
- Rotational type.
Signs of Violation
Each form of the disease has a number of characteristic features:
- The capitate form of the anomaly is noted in 75% of clinical situations, it is considered a common variant of this disease - the urethral opening is lower, it is narrowed, as a result of which urination is difficult. It can be combined with penile deformity, intensified with the start of sexual relations,
- Crown type of disease - urination is impaired, organ deformation is noticeable. Urine excretion occurs as a thin stream, requires effort,
- Hypospadias stem - has a variability of its development depending on the location of the meatus (different levels of the posterior surface of the penis). It is also difficult to urinate, organ deformation is observed, painful sensations in the erectile process are noted. Hypospadias stem does not interfere with sexual intercourse, but in the process of ejaculation the sperm does not penetrate the vaginal area,
- Hypospadias scrotal - recognized as a serious variant of this anomaly. The opening of the urethral opening occurs in the scrotum, dividing it into two halves. An underdeveloped state of the organ is noted - the penis is deformed, similar to a hypertrophic clitoris, the scrotum itself is like the labia. Male newborns with this pathology are often mistaken for girls with adrenogenital impairment. The process of urination usually occurs in a sitting position, the implementation of sexual acts with this kind of disease is not possible due to the curvature of the organ. There is also irritation of the skin of the scrotum,
- Perineal hypospadias - the meatus is located behind the scrotum. The patient has a small organ, bifurcation of the scrotum. The difficult process is to establish the gender of the newborn. This type of disease can be combined with the course of cryptorchidism, the development of inguinal hernia, the presence of dropsy of the testicle membranes,
- Chord type pathology - a short undeveloped urethra is observed, which provokes the deformation of the penis to the bottom. The correct location of the meatus is noted. In the erectile process, the penis resembles the appearance of a bow; painful sensations are possible that interfere with the normal implementation of intercourse.
What are the different forms of hypospadias in newborn boys?
Patients with proximal forms of the disease, micropenia, or with a palpable testis often require special treatment approach.
Such children may need to visit an endocrinologist, genetics, conduct auxiliary methods of examination to determine the karyotype to exclude violations of gender formation.
The following types of hypospadias are distinguished:
- Capitate - the urethral opening is on the head of the penis, but not in a standard place. This type of deviation is the most common. Mostly the hole is just below the top of the head. Cases of genital curvature are infrequent.
- Coronet - urethral opening moved to the coronal groove area. Coronary impaired urination and organ shape. Often when urinating, urine gets on its feet.
- Stem - the channel hole is on the underside of the penis. The penis is very curved, in some cases, narrowing or stenosis of the urethral opening is detected. Patients have complaints about urination disorders, the flow is directed downward, while the process in a standing position is much more difficult, the curvature of the penis happens with a turn to the side.
- Scrotum - the external exit of the urethra is concentrated in the area of the scrotum, the genital organ is small, in severe cases it looks like a clitoris. Bladder emptying can only occur in a sitting position.
- Crotch - the external opening of the urethra looks like a wide funnel and abides in the perineum, the penis is small and also very curved. The external opening of the urinary canal is extremely wide.
- Chord type hypospadias - the urine excretion channel is underdeveloped and short, its external hole is in standard placebut the penis is deformed. Around the canal there are embryonic scars that increase the curvature of the cavernous bodies. With excitement and during puberty, the violation of the form increases.
What are the signs of a disease?
The main sign of rejection is abnormal outlet opening. An existing disease significantly complicates the process of urination.
At capitate deviations male representatives have to raise a member up to aim a stream of urine in the right direction.
Often during hypospadias, the undeformed urination channel has constrictions that greatly complicate the process: the urine stream is thin, intermittent, and the procedure itself requires pressure on the muscles of the press.
Depending on the type of deviation and the location of the urinary canal, the boy may have violation of the structure of a member:
- lack of a spongy body,
- bifurcation of the head, etc.
The lower the urethral opening, the brighter other impairments to the development of genital organs are manifested.
With complaints of pain in the organs of the urinary system during diagnosis, the norm of leukocytes in the urine is often determined, due to which many diseases can be detected.
Kidney hydrocalicosis is a common disease. Why the disease occurs and how to treat it, read our article.
Why can hypospadias occur?
Causes of hypospadias not identified.
According to doctors, the development of this deviation is favored by such reasons:
- Heredity is a major factor in the development of deviations. The risk of a boy with hypospadias is greater in a family where his father also observed this violation.
- Hormonal disruptions during fetal development. The normal development of the penis and urinary canal occurs only if there is a sufficient amount of male hormones in the baby's blood. The lack also causes violations of the structure of the genital organ, undescended testes, hypospadias. That is why the disease is often accompanied with undescended testes.
- Reception of female hormones immediately before pregnancy or at its initial stages increases the risk of a baby with a deviation. For this reason, boys with a deviation are more likely to appear in mothers who have been treated for infertility, or who have become pregnant through modern technologies.
Doctors have determined that hypospadias develops at 10 weeks of fetal developmentwhen the urethra from the urethral sulcus is formed, its departments are connected and when cavernous bodies are formed.
Hormonal malfunctions and genetic abnormalities in the pregnant woman's body, environmental situation belong to the provoking reasons for the appearance of deviations.
Also, the causes of the violation can be transferred rubella, flu, hormone-based medications.
Scientists are inclined to believe that hypospadias in a baby appears more often if the mother used hair fixation spray.
Deviation can provoke phthalate - a chemical that is in hairspray.
Concomitant pathologies and complications of hypospadias
The disease can be combined with genitourinary abnormalities:
- undescended testicle,
- hernia in the groin,
- renal impairment
- also with violations of other organs and systems.
Hypospadias may be the result of more severe defects in the development of the reproductive system.
Sometimes such children in early childhood need a sex change. An illiterate therapeutic approach spoils the life of patients, provokes family problems.
How to treat pathology?
The easiest form of this deviation is capitate. Quite often, only with a slight curvature of a member no treatment needed.
Hypospadias surgery in boys is necessary, if available narrowing of the urethral opening and with a pronounced deformation of the penis, which will provoke problems in the future with sexual life, sometimes it just might not be possible.
Surgical treatment of the disorder - One of the most complex operations in pediatric urology, for the implementation of which requires extensive experience and high professionalism of the doctor.
Optimum surgical treatment for children aged from six months to 2 years.
By the age of 4, the child begins to realize his belonging to the stronger sex. Also, up to 2 years, the baby does not remember events that are related to the operation.
If the disease was not cured in early childhood, then treatment for deviations can be carried out at any age. Surgery in both small and adult is carried out under general anesthesia.
Surgery may be performed simultaneously or in two stages.
Purpose of operation: straightening of the penis and restoration of the missing part of the urinary canal. Creature the correct form of the penis is performed by excision of scar tissue in place of the absent urinary canal.
This makes it possible to create conditions for the correct development of the corpora cavernosa. If the procedure is carried out in two stages, the first one is completed.
If the treatment is carried out at a time, then the restoration of the urethra is performed immediately.
At two-step process operation in progress up to 7 years. The material for restoring the missing part of the canal is the skin of the genital organ, the skin of the foreskin or scrotum.
Occasionally, when the use of the skin of nearby tissues is impossible, an appendix, part of the ureter, and a section of the bladder are used.
As treatment methods are used as ureaplastyso distinction methods.
The ureaplasty procedure often provokes the development stenosis and fistula.
The distant types of intervention are not so technically complicated. At the same time, they restore the work of the penis and urinary canal, as well as the normal form of the penis.
The main thing is that the operation should be carried out in early childhood, and this will provide an opportunity to lead a full life in the future.