What is hypospadias
During fetal development, the urethra is formed by the closure of folds along the undersurface of the penis. If this process is not completed completely, the outer hole remains shifted back.
The defect usually includes three components: a displaced urethral opening, a downward curvature of the penis, and a special arrangement of the foreskin, which covers the glans only from above in the form of a hood.
- Capitate and coronal forms - an opening on the head or at its base; the most common and easiest
- Stem form - hole on the shaft of the penis
- Scrotal and perineal forms - severe variants with significant curvature
- Hypospadias without hypospadias - the hole is located correctly, but there is curvature and a characteristic structure of the foreskin
- Epispadias - the hole is shifted to the upper surface; separate, rarer and more complex defect
Causes and risk factors
- Disorders of urethral formation in early pregnancy
- Heredity: hypospadias in a father or brother increases the likelihood
- Genetic syndromes and disorders of sex development - in severe forms
- Prematurity and low birth weight
- Mother's age
- Hormonal factors during pregnancy
- Exposure to certain environmental substances
- In most cases, a specific cause cannot be determined
What are the risks without treatment?
- Inability to urinate while standing with a normal stream; the stream is directed downward and sprays
- Curvature of the penis, making sexual activity difficult in adulthood
- Difficulty conceiving in severe forms due to impaired sperm delivery
- Narrowing of the urethral opening with difficulty urinating
- Recurrent urinary tract infections
- Psychological consequences and decreased self-esteem in adolescents
- Cosmetic defect
Timing of the operation
An early age is considered optimal, when the child is not yet aware of the peculiarities of his structure, and the tissues are healing well.
- Most often, surgery is planned for the first or second year of life.
- In severe forms, treatment can be multi-stage with intervals between stages
- In some cases, a short course of hormonal preparation is prescribed before surgery to increase tissue size
- In adolescents and adults, surgery is also possible, but technically more difficult.
- Repeated operations after unsuccessful interventions require a special approach and frequent use of the buccal mucosa
How is the operation performed?
- Straightening the penis - eliminating curvature
- Formation of the missing section of the urethra from local tissues, foreskin or buccal mucosa
- Bringing the hole to the top of the head
- Formation of the head and cosmetic correction of the foreskin
- Installation of a drainage catheter for a certain period of time
- One-stage surgery for mild and moderate forms
- Two-stage or multi-stage surgery for severe forms and repeated interventions
- Buccal urethroplasty - the use of the mucous membrane of the inner surface of the cheek in case of deficiency of its own tissues
After surgery and possible complications
- A drainage catheter for a period determined by the surgeon
- Wound care and infection prevention
- Limiting activity in the first weeks
- Urethral fistula is the most common complication requiring a separate minor operation
- Narrowing of the formed opening or the urethra itself
- Suture dehiscence, especially with infection
- Residual curvature
- Follow-up over several years, including puberty when residual problems may appear
- Dynamic assessment of urination using uroflowmetry
Where is surgery performed in Tashkent
Hypospadias surgery requires experience specifically in reconstructive urology: the quality of the first operation directly determines whether repeated interventions will be required.
In Tashkent, urethroplasty for hypospadias, as well as complex repeated operations using the buccal mucosa, are performed at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
Parents should check with the surgeon in advance: what technique is planned, whether the operation will be a one-stage operation, how long the catheter will remain in place, and how the observation will be organized. And be sure to warn any doctor that the child cannot be circumcised before reconstruction. Clinic contacts are below.
