Hypospadias is a maldevelopment in the genitourinary tract. In affected boys, the urethra does not sit at the tip of the penis. This leads to various functional limitations that can be treated surgically.
What is hypospadias?
In hypospadias, the urethral opening is on the underside of the penis and does not open at the tip of the penis. In this case, the urethra is shortened. Depending on the severity, the urethra may then end below the glans or even at the perineum. This makes it difficult for the affected boy or man to urinate while standing, as the stream runs backwards. Hypospadias is one of the most common genetic malformations of the male genitourinary tract. It is not infrequently accompanied by enormous psychological stress for the parents as well as for the affected boy. A distinction is made between glandular, penile and scrotal hypospadias. The mildest form, namely glandular hypospadias, occurs most frequently. In this case, the urethral opening is located on the underside of the glans. In penile hypospadias, the urethra opens into the shaft of the penis, which requires therapy and can lead to functional limitations. The most severe form is scrotal hypospadias, in which the urethral opening is at the base of the penis or perineum.
Causes
Hypospadias is a hereditary malformation. Around the 14th week of pregnancy, urethral formation is usually complete. However, developmental abnormalities or interruptions may occur up to this time. The severity of hypospadias depends on the developmental stage at which the disorder occurs. In addition to the hereditary factor, endocrinological and environmental influences also play a role. For example, a defect in the receptors for testosterone has been demonstrated. If the mother takes the hormone progesterone during pregnancy, this may increase the baby’s risk of developing hypospadias. In addition, babies born underweight appear to have a higher than average incidence of hypospadias. However, the exact factors leading to this condition are not yet fully understood.
Symptoms, complaints and signs
Hypospadias can be identified primarily by the shortened urethral opening. In boys, the urethral opening usually ends under the glans, while in girls it ends in the vaginal wall. Individuals suffering from hypospadias have problems urinating and ejaculating. During urination and sexual intercourse, there may be pain and burning sensation, which usually subsides after a few seconds to minutes. Furthermore, the malformation manifests itself through repeated infections and inflammations in the affected area. Those affected are generally severely restricted in their daily lives and, in addition to the actual symptoms, also suffer from avoidance behavior and the consequences that result from this. For example, regular urinary retention can cause inflammation and, in the worst case, lead to incontinence. The avoidance of sexual intercourse also results in psychological problems, among other things. Those affected often feel extremely uncomfortable with the condition and withdraw from social life. The often chronic symptoms can cause psychological discomfort in patients and lead, for example, to the development of inferiority complexes and depressive moods. For this reason, hypospadias must be diagnosed early and corrected by surgical intervention.
Diagnosis and course
The basic diagnosis is made by the treating urologist after a detailed physical examination. Then, in most cases, a sonography of the urethra is ordered. Among other things, this serves to clarify the degree of severity. If the ultrasound examination is conspicuous, a urogram is subsequently prepared. This is a contrast medium X-ray of the kidneys as well as the urinary tract. In addition to these diagnostic measures, a micturition cystourethrography (MCU) can also be performed, in which the bladder is subjected to an X-ray examination before and after urination. As part of the diagnostic process, it is also important to determine the severity of hypospadias. Basically, the course of hypospadias is absolutely positive with the right therapy. In many cases, the maldevelopment can be corrected both cosmetically and functionally by appropriate measures.
Complications
Hypospadias causes the patient to experience discomfort in the genital organs.In most cases, the patient suffers from discomfort during ejaculation and urination. This can cause severe and burning pain, which negatively affects everyday life. In addition, most men suffer from pain during sexual intercourse. Psychological complaints can often develop as a result of this pain, leading to inferiority complexes or lowered self-esteem. Furthermore, depression and other psychological discomfort can also occur. Hypospadias does not need to be treated in every case. If the patient does not suffer from severe symptoms or feels restricted in his everyday life, treatment is not mandatory. In this case, there are no complications. Treatment is necessary if the hypospadias leads to pain or severe psychological complications. In this case, surgical intervention is usually necessary. This procedure also does not cause any particular complications. In rare cases, the incision sites may become infected after surgery and therefore need to be treated with antibiotics. Life expectancy is not affected by hypospadias.
When should you go to the doctor?
Hypospadias is usually diagnosed immediately after birth. Whether further visits to the doctor are necessary depends on the severity of the malformation and any accompanying symptoms, among other factors. A slight urethral opening can be closed immediately after birth and only requires a few check-ups afterwards. More severe malformations, which may be associated with problems with urination and ejaculation, require extensive medical treatment. Parents should take the child to the doctor if he or she complains of pain during urination or shows symptoms of fever. If the urethral opening becomes inflamed, further medical treatment is indicated. The affected person should be taken to a urologist immediately. Early treatment reduces the risk of serious complications. Therefore, hypospadias should be clarified and treated as soon as possible, regardless of whether other complaints are added. Children born to mothers who take the hormone progesterone during pregnancy are particularly likely to be born with hypospadias. That’s why expectant mothers who take regular medication should talk to their doctor regularly and have their child’s health checked.
Treatment and therapy
In mild cases of glandular hypospadias, no therapeutic intervention is usually necessary. It is not uncommon for those with very mild forms to be unaware of their hypospadias. However, if functional limitations are present, surgical intervention is usually recommended. This is ideally performed from the first year of life of the affected boy. If the urethra is narrowed, surgery may already be necessary in infants. It is a complicated operation that can take several hours. The operation always takes place under general anesthesia. To correct hypospadias, there are different surgical approaches depending on the present severity of the maldevelopment. Surgeons must also be aware of other urogenital tract malformations that often occur along with hypospadias. These include maldevelopment of the erectile tissue in the penis or curvature of the penile shaft. It is also not uncommon to have a split prepuce, which means that the foreskin is longer on one side and missing on the other side of the penis. During surgery, the urethra is placed at the tip of the penis. This is to allow normal urination or erection. In addition, surgeons try to straighten the penis.
Prevention
Since hypospadias is a genetic or endocrinological maldevelopment in the urogenital tract that occurs during early pregnancy, prevention is not possible.
Follow-up
Once hypospadias has been treated, small bruises and swellings may develop. However, these heal after about four weeks. Children who have had surgery need regular follow-up appointments. They usually stay in bed for two to three days and keep the bandage on for three to seven days. After careful removal and clamping of the abdominal catheter, the child is allowed to urinate normally. Depending on the treatment method, the healing process may take a little longer. Chamomile baths accelerate healing.The penis should be restored after four to six weeks at the latest. During the control examinations, the doctor convinces himself of the patient’s condition. Immediately after the operation, children often feel slight pain. When the penis has healed, a scar remains, which runs in a ring shape under the glans and sometimes also along the underside. This is where the similarity to traditional circumcision becomes apparent. Follow-up care at home involves some caution when walking and making other movements. Often, children automatically take care not to move too violently. However, parents can also be careful that their offspring do not exercise too soon. The one-week sick leave is an important support in this regard.
This is what you can do yourself
If there is only a slight malformation in the glans area, hypospadias does not need to be treated in most cases. Nevertheless, pain may occur during urination and, later in life, during sexual intercourse, which, insofar as it is a mild discomfort, can be treated by means of mild painkillers from the pharmacy. In the case of more serious complaints, surgery may be necessary. After such an operation, the affected person can promote recovery by observing appropriate hygiene measures and taking care of the area where the operation took place for a few days. Activities that could strain the penis and the intimate area in general should be avoided in the first period after the operation. Since surgery usually takes place in the first two years of life, parents must watch for any abnormalities and contact the doctor in charge if there are signs of pain or similar symptoms. Other measures are limited to taking good care of the surgical scar to prevent the development of a larger scar. The child should be informed as much as possible about the reasons for the surgery.