In my 27 years of professional life, I have always said that "one of the biggest reasons for me to be a pediatric urologist is hypospadias surgeries". Because the surgeries I enjoyed most during my pediatric surgery training years were hypospadias surgeries. I still get the same pleasure even in the simplest hypospadias surgery. In my opinion, especially its severe forms, it is one of the true reconstruction surgeries.
I personally approached 1500 hypospadias surgeries in total. I always thought about how to have less complications, how to be more aesthetic and tried to go over these problems. Therefore, studies on hypospadias have an important place in my pediatric urology life.
The disease, which we call hypospadias in the medical language, is known as congenital circumcision, half-circumcision or prophetic circumcision among the people. Its incidence is 1 in 250 births or 0.8 in 125 live male births.
hypospadias; It can be defined as a disorder of the urinary opening (urethra), foreskin and anterior surface of the penis. Hypospadiasa is accompanied by chordee anomaly, which affects the clinical picture and the success of the surgery. chord; It is the forward curvature of the penis during erection. Sometimes, severe chordates play a role in obscuring the external genitalia of newborns with severe hypospadias (See "Sex Developmental Disorder" for detailed information).
The exact cause is not known, but many factors are thought to be involved. If there is hypospadias in the family, there is 10% genetic transmission. Apart from these, hormonal deficiency, environmental pollution, all kinds of substances that affect our genetics play a role in the formation of hypospadias. In most cases, hypospadias develops spontaneously with no underlying cause. In general, the more severe the hypospadias, the more an underlying cause can be identified.
According to the location of the hypospadias urinary hole; It can be classified anterior or distal (glandular, coronal, subcoronal), middle (midpenile), posterior or proximal (posterior penile, penoscrotal, scrotal, perineal). It is the most common subcoronal position. The group of patients with proximal hypospadas is considered severe (severe) cases.
The most common anomalies accompanying hypospadias are; undescended testis, inguinal hernia and kidney anomalies. The incidence of these secondary anomalies is between 10-15%. Therefore, kidney ultrasound is requested from patients with hypospadias. If one or both testicles are not palpable in a child with hypospadias, doctors suspect the possibility of a “Sex Developmental Disorder” (See “Sex Developmental Disorder” for detailed information”).
The only treatment for hypospadias is surgery. More than 300 surgical techniques have been described so far. The recommended age for surgery is between 6 months and 18 months. Single session surgery techniques are used in mild and moderate cases, and two-session surgery techniques are applied in severe cases. Since the foreskin is used in two-stage surgeries, patients with hypospadias should never be circumcised.
The aim of hypospadias surgery is to obtain a functional and anatomically correct penis by creating a normally located urinary hole. As a result of the operation, a flat penis for sexual intercourse, a urinary hole moved to the tip of the penis, a smooth urine discharge while standing, and a normal-thickness urine hole are created. While doing these, it is expected to have as few complications as possible.
A complication rate of 10% in moderate and 50% in severe cases was reported. Therefore, it is necessary to consult pediatric urologists or pediatric surgeons specialized in this subject.
In 5-10% of patients with hypospadias, the foreskin is complete. This group is called “megameatus intact prepisium”. Usually these children are diagnosed during circumcision. Therefore, children who want to be circumcised must be examined by a specialist before circumcision.