Hypospadias- Causes, Symptoms, Diagnosis, Treatment, and Prevention

Introduction:

Hypospadias is a common anomaly of the penis that occurs during embryonic development in which the urethra does not open at its normal position in the penis head. It is the second most frequent male reproductive system birth anomaly. Hypospadias is a relatively frequent condition that can occasionally be left alone. However, doctors can perform surgery to correct the condition if necessary.

What Is Hypospadias?

Hypospadias is an abnormal condition in which the meatus is not located at the penis tip. Rather than that, the hole may be located anywhere along the underside of the penis. The meatus (hole) is most frequently located around the penis end ("distal" position). However, it can be situated anywhere between the midpoint of the penile shaft and the base of the penis or even within the scrotum (proximal positions). Over 80 % of males who suffer from this condition have distal hypospadias. In 15 % of those cases, the penis also curls slightly downward, a condition known as chordee. Curvature occurs in more than 50 % of patients as the meatus opens further down the shaft.

What Are the Types of Hypospadias Identified?

The position of the abnormal urethral meatus is used to classify hypospadias. The following is one of the most frequently used classifications by physicians.

• Subcoronal: Near the penis head.

• Midshaft: Along the midshaft of the penis.

• Penoscrotal: Opening at the junction of the penis and scrotum.

Nearly 50 % of occurrences have an anterior site, 20 % have a median placement, and the remaining have a posterior location. In general, the sub-coronal position is the most frequently encountered abnormal site.

What Are the Causes of Hypospadias?

Although the specific cause of hypospadias is unknown, it is thought to be a combination of genetic, endocrine, and environmental factors. The following are some of the possible causes of hypospadias, according to the researchers:

• Genetics: It is more likely to have this condition if the boy's father or brother was born with the condition. Additionally, it can be connected with other genetic syndromes.

• Treatments for Fertility: The mother may have taken hormone therapy or prescription medication to get pregnant.

• Age and Weight of the Mother: There is a greater possibility that a baby will be born with hypospadias if the mother is overweight and above the age of 35 or if the mother has diabetes before pregnancy.

• Exposure to cigarette smoke or pesticides.

• Premature birth of the baby.

What Are the Symptoms Seen in Babies With Hypospadias?

Symptoms of hypospadias in children include the following:

• Chordee: The penis curls downward.

• Undescended Testicle: One of the testicles has not totally descended into the scrotum (in about 10 percent of cases).

• Undeveloped Foreskin: The skin surrounding the penis head is not fully developed.

• Abnormal Urination: Urine does not pass in a straight stream.

How Are Hypospadias Diagnosed?

Hypospadias is detected soon after birth. The meatus is positioned incorrectly, and the foreskin's underside is frequently incompletely developed. This creates a dorsal hood that exposes the penis tip. Often, it is the appearance of the foreskin that draws attention to the problem. Nevertheless, some babies are born with an atypical foreskin with the meatus in the normal location. Additionally, a full foreskin may conceal an abnormal meatus in some cases. Around eight in every hundred boys with hypospadias have a testicle that has not completely fallen into the scrotum. If hypospadias is detected, the pediatrician will recommend you to a pediatric urologist for treatment. Hypospadias correction may be necessary to resolve the issue.

How Is Hypospadias Treated?

• Hypospadias is surgically corrected. The sort of reconstruction techniques required is determined by the degree of hypospadias. While the majority of moderate forms can be treated in an outpatient setting, severe forms may require two or more treatments and may require hospitalization.

• The purpose of the reconstruction surgery is to straighten the penis (fix the chordee), bring the opening (meatus) to the tip of the penis, and restore the penis to its normal cosmetic appearance.

• Although surgical correction can be performed at any age, most pediatric urologists undertake the procedure between the ages of six to 17 months.

• However, hypospadias can be corrected in children of any age, including adults. If the penis is tiny, the physician may recommend testosterone (male hormone) treatment before the surgery.

• Hypospadias correction is frequently performed the same day in a 90-minute (for distal) to three-hour (for proximal) procedure. In some instances, the restoration is accomplished in stages for the severe proximal chordee cases, which might take a few more days.

What Are the Complications Following the Surgery for Hypospadias?

• Fortunately, most procedures were successful the first time. Nonetheless, a few children require additional surgery due to complications. A majority of them achieve success the second time. Nevertheless, a few patients may experience complications that necessitate further surgery. However, these issues are resolvable.

• Following surgery, complications include fistula (a hole in the repaired channel) identified by urine flowing from a second opening while the child is urinating, and meatal stenosis (scarring of the new opening), which is detected by the constriction of the urine stream.

• Additionally, the new channel produced may scar and result in a stricture, or perhaps the repair may fail sometimes.

• Each of these issues necessitates additional surgical repair. Complications have been significantly reduced as surgical procedures have advanced.

Immediate medical help must be given if the child encounters any complications after surgery and if the child has the following symptoms:

• Fever for more than 24 hours, 102° Fahrenheit or higher.

• Having difficulty peeing or being unable to pee.

• If any blue or gray discoloration at the tip of the penis is seen.

• Discomfort despite the use of pain medicines.

• There is bleeding from the surgery site.

How to Prevent Hypospadias?

There is no guarantee that the condition can be prevented. Still, the chances of the baby getting affected by this condition can be minimized by taking some precautionary measures while pregnant. The measures to follow are:

• Avoid smoking and consuming alcohol.

• Keep a healthy weight.

• Pregnant women should take Folic acid (400 to 800 mcg per day).

• Consult the healthcare practitioner for routine prenatal examinations.

Conclusion:

Hypospadias can create urine and sexual function issues if left untreated. However, treatment for hypospadias is highly effective. Surgery straightens the penis and adjusts the hole. And in most cases, hypospadias repair is permanent. If there are any further concerns or doubts relating to hypospadias, please do not hesitate to reach out to icliniq for further information.