1. What is hypospadias?
Hypospadias, or abnormal urethral openings, is a common congenital malformation of penis development in children, with an incidence of about 8 ‰ in male newborns. In addition to affecting the normal life of children, it can also cause great psychological trauma. The etiology of hypospadias is currently considered to be a polygenic genetic disease with a certain familial predisposition.
There is currently evidence that patients with severe hypospadias have a relatively low level of testosterone that can persist into adulthood. If moderate or severe hypospadias are not treated, the patient's sexual function and behavior can be affected.
Once the diagnosis of hypospadias is confirmed, surgery should be performed at an appropriate time to correct the curvature of the penis, making the urethral opening as close to the normal position as possible. Children can stand and urinate, and as adults, they have reproductive ability. The surgery should be performed in a large hospital with a pediatric urology specialty.
2. Classification of hypospadias
According to the position of the external orifice of the ectopic urethra, hypospadias can be divided into four types:
① Penile head type: The urethral orifice is located on the ventral side of the penis, mostly in a fissure shape
② Penile type: The urethral orifice is located on the ventral side of the penis, anywhere from the coronal sulcus to the junction of the scrotum and penis
③ Scrotal type: the external orifice of the urethra is located in the scrotum
④ Perineal type: The external orifice of the urethra is located in the perineum. Due to the hypoplasia of the distal urethra and surrounding tissues of the ectopic urethral orifice, forming fibrous cords that involve the penis, hypospadias are often accompanied by varying degrees of downward curvature of the penis.
3. The best surgical opportunity for hypospadias
Patient: When should hypospadias be treated? Is it better to treat as soon as possible?
Doctor: The best surgical opportunity for hypospadias is 10-18 months, with an age of over 6 months, a weight of over 10 kilograms, and a well-developed penis. Generally, patients are required to complete treatment around the age of 3 years before their sexual psychology develops. Endocrine examination and treatment should be carried out first for patients with penile dysplasia, and older patients who have failed treatment should receive treatment as soon as possible. Patients with urethral stricture or difficulty urinating after treatment failure should be treated again immediately.
4. Hypospadias surgery
Patient: What effect can be achieved after surgical treatment of hypospadias?
Doctor: The basic method for repairing hypospadias is to correct the bent penis and use autologous tissue to reconstruct the missing urethra. According to the types and transfer methods of tissue transplantation during urethral reconstruction, it can be divided into mucosal and skin free transplantation and local flap pedicled transfer. The central principle is to restore the length and shape of the penis as much as possible, and flexibly use various tissue transplantation methods to reconstruct the urethra.
Restoring the morphology and function of the normally developed penis and urethra is the ultimate desire of plastic surgery for hypospadias. The basic criteria for urethral reconstruction are: the diameter of the reconstructed urethra is appropriate, without twists and turns; The urethral lining is smooth and smooth without hair growth; The external orifice of the urethra is located at the top of the glans, in a longitudinal fissure shape; Urine flow is linear, without scattering, and has good directionality; The reconstructed urethra has growth potential and can grow and develop together with the penis. Generally speaking, formal and experienced specialized hospitals can achieve the above requirements through careful preparation.
5. Are there any sequelae from hypospadias surgery
Patient: What if I have undergone surgery and still have poor penis development?
Doctor: After the patient reaches puberty, if there are still cases of smaller penis development and penis scrotal transposition (i.e., the penis is buried in the scrotum), local plastic surgery of the perineum should be considered and penis lengthening and thickening surgery should be performed. For patients with basically underdeveloped penises, penile reconstruction is necessary to reconstruct the morphology and function of the penis and urethra.