Hypospadias - Causes, symptoms and treatment. MF.

Hypospadias are an anomaly of the development of the penis, when the outer opening of the urethra opens not on the head of the penis, but on the trunk of the latter. In this case, the urine stream loses its physiological direction and the patient experiences certain difficulties during the act of urination.

Types of hypospadias

Causes of hypospadias

Hypospadias are a completely congenital anomaly of development that occurs in children from the very moment of birth. It is difficult to single out the unique cause of this pathology, since there are many factors that can affect the normal laying of the fetal organs during pregnancy.

First of all, it is necessary to identify infectious diseases that can lead to congenital malformations. To date, the role of toxoplasm and cytomegalovirus has been proven in the developmental anomalies. Therefore, all pregnant women should, several times during pregnancy, take tests for these pathogens. In addition, it is necessary to screen for congenital syphilis and AIDS, which are also the causative factors of many vices.

In addition to infectious diseases, the causes of congenital developmental abnormalities can be a variety of physical and chemical factors. Thus, it is not recommended to pregnant women to engage in mobile work or to contact chemicals such as washing powders, detergents, varnishes, paints and others unnecessarily.

A large number of newborns with hypospadias are found in contaminated areas with radioactive substances, which allows one to draw conclusions about the negative effect of radiation on fetal development.

Some medications, in particular chemotherapeutic and anti-tuberculosis drugs, can also be the cause of hypospadias in a newborn, so you need to be extremely careful when using any medication during pregnancy.

Symptoms of hypospadias

The only clinical sign of hypospadias is the presence of an external hole in the urethra not on the glans penis, but on its trunk or even on the scrotum. In principle, the form of hypospadias is determined from where the hole is located. At the mildest form of the disease, the hole of the urethra is on the head, only slightly below its usual location. At the same time, the urine stream practically does not change and the disease can be unnoticed even before puberty.

Much more difficult is the disease, if the urine stream leaves the trunk of the penis or even the scrotum. There is no mucous membrane, and with constant urine on the skin, soon there is irritation and inflammation. If this occurs during the newborn period, then the overall condition of the child worsens. He becomes capricious, refuses his breast, bad gaining weight. Immediately identify the cause of this behavior is difficult, because the child urinates in the diaper and the parents do not see the jet of his urine. Redness of the skin in the genital area is usually perceived for intertrigo.

At an older age the child understands his problem and even learns to urinate smoothly. Only against this background does he develop psychological complexes, which are especially aggravated in adolescence, when his peers begin to live sexually.

If a similar problem is found in your child, it should be immediately shown to the urologist so that he or she selects the right treatment tactics.

Diagnosis of hypospadias

As a rule, the clinical picture of the disease is enough to put the right diagnosis and determine the tactics of treatment. But it is necessary to exclude another pathology, such as urethral fistulas, which can also give a similar clinical picture.

For this purpose, a study such as urethrography is carried out. The essence of the method consists in intravesical administration of contrast medium, after which during the act of urination a radiographic examination of the small pelvis is performed. In the picture you can see the course of the urethra and the place of its opening on the penis.

Urethroscopy, which would seem to be an effective method of diagnosing this disease, is not used at all because of the high danger of damaging the wall of the urethra.

Treatment of hypospadias

The only effective and justified method of correction of this pathology can be considered only surgical intervention. The scope of the operation depends on the specific form of the disease, but in all cases, the main task of the urologist is to restore the normal form of the urethra.

If it is a head form of hypospadias, when the opening of the urethra opens on the head of the penis, the plastic is performed solely by its own tissues. For this, in the necessary place of the mucous membrane, an opening is made, into which the urethra, previously mobilized from the place of its previous fixation, is excreted.

With more complex forms of hypospadias, when the opening of the urethra opens on the trunk of the penis or scrotum, one's own tissues are usually not enough to effectively hold the urethra plastic. In such situations, a variety of synthetic prostheses are used, which are made from hypoallergenic material.

Operative treatment of hypospadias

Rehabilitation after illness

For the correct formation of the urethra, in the first post-operation operation, patients are placed the urethral catheter to evacuate the urine. The patient's task in this case is proper care of the catheter for the prevention of pressure ulcers of the urethra. The patient needs to be told that the tube needs to be changed almost every three days, and every day, inject antiseptic solutions into the bladder cavity.

Psychological rehabilitation is of no small importance, as many patients develop complexes, in connection with the violation of sexual life. It takes on special significance in adolescents, when the problems of sexual life go almost to the fore. Psychologists usually work with these children, explaining to them the need for temporary wearing of the urethral catheter and the importance of the operation performed.

Antibacterial prophylaxis of secondary infection is performed by intravenous and intravesical administration of solutions of antibiotics and antiseptics. To this end, you can use furacillin, furamag or chlorhexidine, which are effective against both gram-positive and gram-negative flora.

Nutritional and lifestyle characteristics of

Patients after a previous operation do not need special dietary nutrition. As a rule, they consist of a general high-calorie table number 15, which includes nutritious foods with a uniform content of protein, fats and carbohydrates.

As already mentioned, lifestyle features consist in abstinence from sexual relations, when it comes to adult patients. To prevent erection, which can cause a rupture of urethral anastomosis, patients are prescribed sedatives based on bromine.

Treatment with folk remedies

Because hypospadias are purely surgical pathologies, it is not necessary to talk about folk methods of treatment. The only thing that can be advised to patients is the use of lotions with a solution of chamomile on the macerated skin of the penis and scrotum.

Complications of hypospadias

As already mentioned, the most common complication of hypospadias can be considered skin irritation and dermatitis, which arises from the constant exposure of urine to it. At first, this is manifested by a slight reddening of the skin around the opening of the urethra, and later can pass into ulcerative necrotic inflammation with the formation of a purulent deposit. If the treatment of the first stage of the disease can be limited to the local use of antiseptic solutions, then with purulent inflammation it is necessary to perform a primary surgical treatment of the wound. Its goal is to completely remove the altered tissue and apply an aseptic dressing that prevents secondary infection.

No less important is the psychological complications of the disease. In severe forms of hypospadias, difficulties often arise when trying to urinate normally. At patients clothes constantly are spoiled by urine. Because of the bad smell, they do not always find understanding in the team. Often this becomes the cause of deep depressions, turning into acute psychosis. Literature is known cases when hypospadias became the cause of suicide. It is worth noting that such situations are most often observed in dysfunctional families, where children may not know about the congenital anomaly of development before they grow up.

Prevention of hypospadias

Prevention of hypospadias is the task, first of all, of a pregnant woman, who must actively engage in pregnancy and prepare for the birth of a child. First and foremost, she must pass all tests for infections that can lead to the development of congenital anomalies. Recall that such diseases include rubella, herpes, toxoplasmosis, cytomegalovirus, syphilis and AIDS.

If a pregnant woman lives in a zone with high radioactive contamination, then it is better for her to change her place of residence during pregnancy.

For the duration of pregnancy, it is necessary to minimize contact with a variety of chemicals, such as paints, varnishes, detergents and cleaning agents. If this is not possible, it is advisable to use rubber gloves when working with similar substances.

Forecast of hypospadias

Prognosis for life is favorable, regardless of the form of the disease. Even if you do not take any medical procedures, the disease does not threaten a strong deterioration in the health of patients and, especially, the death of the latter.

The prognosis for recovery is relatively favorable. Despite the possibilities of modern surgery, there are forms of the disease in which even surgical intervention can not completely eliminate the cosmetic defect of the skin of the penis.

Forecast for working capacity - favorable. Regardless of the form of the disease, as well as the surgical procedures performed, patients with hypospadias can engage in any type of work.

Rev.the doctor the urologist, the sexologist-andrologist Plotnikov AN