Hypospadias
It is a congenital anomaly of the male genital organ, the penis.
In hypospadias, the urinary canal in the penis is short, and its opening is not at the tip, but somewhere on the underside of the penis. Due to the missing foreskin on the underside, these children were also called “Half Circumcised”. In severe forms, there is a downward curve (curvature) in the penis, which is especially evident on erection. The child has difficulty in peeing on standing, the appearance of the genitals is not normal, and sometimes even looks like female genitalia. It occurs once in every 300 live male births. The cause is mostly unknown.
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DIAGNOSIS
Examination is sufficient for diagnosis and must be noticed at birth. In most cases, no additional testing is required. The level at which the urinary canal opens on the underside of the penis is important for the type and success of the surgery. In case of opening close to the tip of the penis (distal), additional problems are usually not observed. In case of opening close or in the scrotum, additional problems related to kidney, urinary canals and urinary bladder may accompany. For this reason, evaluation with ultrasonography and/or blood and urine tests may be required for further diagnosis in severe types.
Pre- and postoperative view in a severe hypospadias case
(from the personal archive of Prof. Dr. Ä°brahim Ulman)
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TREATMENT
Today, there are different surgical methods according to the type of hypospadias. There is a rapid growth of the penis in the first 6 months of life. Considering that the period between the ages of 2.5-5 is not psychologically appropriate, the operation should be performed at a young age between 6 months and 2 years. The child who begins to recognize his genitals after 2 years of age should not remember the genital problem at all. Therefore, the operation is better completed before the age of 2 years. Contrary to popular belief, the baby's use of diapers is more advantageous in many ways.
Even though it is decreasing today, a common mistake is that these children are circumcised unconsciously. This complicates the treatment. Because the foreskin is often used in surgery. In the operation, the missing distal part of urinary canal is created and the curvature, if any, is corrected. With surgical treatment, the penis looks as normal. Circumcision can be performed simultaneously.
Pre- and postoperative view in a milder case
(from the personal archive of Prof. Dr. Ä°brahim Ulman)
The choice of surgical method is made according to the severity of the disease. The surgery is performed under general anesthesia. Depending on the severity and surgical method applied, the operation takes approximately 1-5 hours. During surgery, a catheter is placed in the newly created urinary canal to drain the urine, and the patient is discharged home with this catheter a few hours after the surgery. This catheter is removed approximately 5 days after the operation. Anesthesia is not required for the catheter removal. Post-operative dressing is not changed daily. He can take shower the next day.
The surgical treatment of hypospadias has some special features, and the operations performed by inexperienced surgeons, who are not used to the characteristics of the baby's body and requirements, who do not have proper training on these issues, can lead to complications that are difficult to correct (curvature in the penis, stenosis in the newly formed urinary canal, urine leakage, poor cosmetic appearance, repeated surgeries and psychological problems).
*** If you see a deformity in your child's penis, consult a doctor. Even if only the foreskin seems to be missing, do not get your child circumcised without the opinion of a specialist dealing with pediatric urology or pediatric surgery.