Hypospadias is a congenital disorder that can be seen in boys. In a normal child, the urine canal ends at the end of the penis head and exits the end of the child’s urinary penis. In the child with hypospadias, the urinary canal is not on the end of the penis, but on the underside of the penis and behind it. The urinary canal did not form at the area between the end of the urinary canal and the tip of the penis.Due to underdeveloped external urinary tract which is called urethra, instead of ending at the tip of the penis where the urinary canal should be, ending at the lower part of penis, which is between the penis body and the testicle bag (scrotum) or between the scrotum and the anus is called hypospadias. Hypospadias is also known as half circumcision. This is because in children with hypospadias usually the foreskin is not fully formed.
The problem of hypospadias is not only the disorder of the opening point of urinary canal. Underdeveloped tip of penis, not fully developed the foreskin, the kordi which causes curvature of the penis when it erectsand the flattened penis can be also seen.
Hypospadias takes various names as anterior, middle and posterior hypospadias according to the location of the urinary canal hole.The more distance between the end point of the urinary canal and tip of the penis, the more serious it is. However, in most children with hypospadias, the urinary canal ends at nearly the end of the penis.
WHAT ARE THE SYMPTOMS OF HYPOSPADIAS?
1) The urine channel is not at the end of the penis, but on the underside of the penis and behind it.
2) Flat head of the penis
3) Circumcision of the forehead of the penis head (half circumcised)
4) Downward spinning of the penis aterection
5) During urination, the urine flows towards the feet, not across.
This is why these children are unable to pee while standing and they have to pee while sitting.
HOW İS HYPOSPADIAS DIAGNOSED?
Hypospadias is easily understood by the doctor’s seeing and examining the baby. Sometimes the foreskin may be normal in children with hypospadias. In these cases, hypospadias may not be detected without forcing the foreskin backwards. It is also possible to diagnose prenatal diagnosis by ultrasonography taken during pregnancy.
WHICH TESTS MUST BE MADE?
In children with hypospadias, problems such as undescended testis and inguinal hernia are common. Therefore, the testicles of children with hypospadias should be checked if they are in the bag.
Some hypospadias cases may also occur as part of very rare gender differentiation problems. Therefore, sex suspicion tests (such as chromosome analysis) should be performed in such suspected children.
The only treatment for hypospadias is surgery. When the erection of the penis, the tapes that cause the penis to curl down are cleaned and flattened when the penis is erection.
The new urine canal is formed by completing the urine canal between the point where the urinary canal opens and the penis end. The flattened penis is reshapedas conical which is normally required.
There are different surgical techniques to be applied according to the type of hypospadias. The operation may last between 1-4 hours according to the chosen technique.
SHOULD CHILDREN WITH HYPOSPADIAS BE CIRCUMCISED?
The foreskin is used during hypospadias surgery to create a defective urinary tract. Therefore, this precious material should not be spent by circumcision. In other words, circumcision should not be performed in children with hypospadias.
AT WHAT AGE SHOULD THE HYPOSPADIAS SURGERY BE PERFORMED?
In the studies performed, it was shown that the risk of the child being adversely affected psychologically in the operations performed after the 18th month. Surgery at a younger age than 6 months increases the risk of general anesthesia. Therefore, the best time for surgery is between 6 and 18 months.