Surgery for hypospadias in a child: types, complications, rehabilitation

Hypospadias — a malformation of the urethra, manifested by the abnormal location of the external opening. In addition, there is often an adjustment of the foreskin on the back of the penis, a surplus, and on the lower surface, the deficiency that distorts the sexual organ. Some patients note the rotation of the penis. In most cases, the penis curves downwards, which erectile dysfunction, and sometimes makes it impossible for fertilization women, because sperm is not deposited in the vagina

Why is hypospadias

According to various sources, this anomaly is fixed 0.5 to 5% of newborn boys and has a tendency to increase. Experts attribute this phenomenon to the increase in the number of pregnancies using assisted reproductive technologies, hormonal drugs to maintain pregnancy, Toxicological effects, adverse influence of external conditions, heredity, etc.

Please note

There is evidence that in-vitro fertilization the incidence of hypospadias is increasing in 5 times (study Silver RI et al 1999).

What impact has hypospadias

First, it is difficulty urinating, the lower is the opening of the urethra, the more necessary to piss on the “female type” sitting.

Often urine flow is curved or sprayed.

A curved penis is abnormally open urethra leads to the impossibility of a full sexual life.

Inferiority complex, depression, apathy — a satellite of the man who was not timely, as children operated.

Diagnosis

Diagnosis itself does not pose difficulties, diagnosis is the outside of the vehicle. All newborn boys in the mandatory examined for hypospadias.

A child with this malformation were referred for a consultation genetics and an endocrinologist.

Diagnostic search is aimed at establishing other organ pathology of the urogenital tract, as in some cases, hypospadias can be combined with other malformations.

Occur severe forms of hypospadias with psevdogermafroditizm.

For reference:psevdogermafroditizm — a condition in which the internal sex organs of female and external male or Vice versa.

Of concomitant of hypospadias abnormalities, revealed the following:

Many parents wonder: “is it Possible the definition of hypospadias when a routine ultrasound during pregnancy?”. Experts believe that there is. The size of sexual organs is so small that it is not always possible to correctly determine the sex of the baby, not to mention the deeper details. Especially since even if it were possible to diagnose this pathology in utero, surgical treatment still is carried out after the birth of the deadlines.

When is the best time to perform an operation on the occasion of hypospadias

Currently, the optimal period is the age of the child from 8 months to 3 years. There are experts who are of the opinion that surgical intervention is better to run earlier: 6 to 9 months. This is due to the lack of injury to a child requiring early surgical intervention, creating opportunities for the full development of the corpora cavernosa and normal growth of the penis.

For the correction of mild enough one operation, with complicated forms of hypospadias can run multiple surgical interventions.

The first stage includes closure of the skin defect and the formation of the flap missing urethra from skin graft foreskin, or scrotum.

Re-operation was performed in 4 — 6 years of age, the intervention aimed at completing the formation of a new urethra of adequate diameter for the normal passage of urine.

When combined pathology do the correction of anomalies of the upper and lower urinary tract, that allows to keep the functional ability of the kidneys, and only then begin to correct malformation of the urethra.

What are the indications for surgery

Isolated indications which are expressed in functional disorders and indications associated with a cosmetic defect. To functional are:

  • rear hypospadias;
  • curvature of the penis;
  • splashing of urine, its deviation;
  • narrowing of the external opening of the urethra.

Cosmetic indications for surgical intervention are:

  • anomaly in position of the opening of the urethra;
  • rotation of the penis;
  • malformation of the foreskin;
  • the splitting of the scrotum.

It is important

Surgical intervention by hypospadias of the child implies the following aspects: restoration of the normal shape of the penis; the formation of the new urethra; removing the external opening of the penis head.

Surgery for hypospadias

In modern urology, there are more than 200 modifications of surgical treatment used in hypospadias the urethra.

Previously often performed plastic with a skin flap, in the moment, urologists rely mainly on the operation of Nadsiannia and tubularization urethral plate (TIP). This method is applicable to remedy as distal and proximal hypospadias. Compared to the previously used operations, the advantages TIP the following:

  • less trauma to the surrounding tissue;
  • the quick recovery;
  • fewer complications;
  • technical availability;
  • a shorter duration of anesthetic sleep.

Why is it important to perform the operation in hypospadias the urethra before?

About 40 years ago the correction of hypospadias was performed boys older than 3 years. It was considered that it is technically easier to perform surgical correction in a larger penis.

But later drew attention to the fact that boys have operated in the age of reason, develop in a significant physiological and psychological disorders.

Sometimes before surgery is resorted to adjuvant hormone therapy, which uses hormones. But this is done on strict conditions, after consultation with the endocrinologist. The goal is to increase the size of the penis on the background of the use of testosterone and human chorionic gonadotropin.

It is important

By existing standards a boy with hypospadias should be operated on not later than 1.5 years.

Advantages of early surgical intervention by hypospadias:

  • the smaller age, the better the recovery ability of tissues;
  • more than simple care for the penis after surgery: easier for the baby to wear diapers, so as not to attract attention to the set after surgery urinary catheter;
  • at this age boys are missing spontaneous erections, which increases the risk of postoperative suture line disruption;
  • does not suffer from the psyche of the child, because at this age the baby doesn’t remember much.

The duration of the surgical intervention depends on the type of hypospadias and anomalies that needed to be corrected.

On average, it takes 2 — 3 hours, but the surgery for the hypospadias can last longer.

Note that all procedures are performed under anesthesia, which facilitates surgical correction of the defect in a young child.

Rehabilitation after surgery for hypospadias

After discharge from the hospital for a child at least 24 months watching the surgeon, as it is during this period of time are often recorded complications.

After the surgery the bandage is removed in 5 — 7 days.

To prevent secondary infection prescribe antibiotic therapy penicillin. For local therapy using an ointment with anti-inflammatory action, which is to be applied 4 — 5 times a day.

Diapers should be changed often, every 1.5 — 2 hours. Be sure to “ventilate” the scar, but to ensure that the child is not pulled out the urethral catheter located in the bladder for at least 2 weeks.

What can be complications and troubles after surgery for hypospadias

Pain syndrome relieved by medications prescription from the group of NSAIDs in the form of syrups, which have anti-inflammatory and analgesic properties.

The origin of the pain is understandable: first, a surgery; second, the urinary catheter affects the bladder neck with many nerve endings than provoked spasms. Applying warm diaper on the abdomen a few relieves.

Bleeding in the first days after surgery should not bother, in the absence of severe bleeding. A few drops of spotting on the diaper allowed.

The most unfavorable complication is the infection of surgical wounds, which may reduce to zero all efforts of the surgeons. Therefore, it is important not to abandon the antibiotic, not to reduce their own dosage and do not skip any doses.

The formation of a fistulous develops on the background of the divergence of seams and wicking of urine in the surrounding tissues. If there is no concomitant stricture of the urethra, there is a possibility that a small fistula will pass on their own.

The newly formed stricture of the urethra requires begerovaya, with the failure resorted to laser excision of the defect.

Do I need to do the surgery the child with a “light” form of hypospadias

To “easy” forms include capitate, okolovenoznoe, and coronal hypospadias. To do surgery necessarily, because all the same psychological aspects in adulthood can lead to adverse consequences. According to statistics, these boys are still operated, but only at a later age.

Stem, scrotal, perineal hypospadias becomes significant psychological trauma for parents. You must realize that to correct the pathology can only surgery that and will be a major challenge.

Accusing each other of poor heredity, hoping for a “miracle” and the resolution of the situation, at the least, unconstructive.

In the most severe form of hypospadias the penis is so small in size that resembles a clitoris, the scrotum because of the splitting is similar to the labia, and urethra — vagina. The testicles in the scrotum may be absent because of cryptorchidism.

In this case perform a blood test for a karyotype to determine the sex of the child, as a girl can be, in fact, a boy. But even these hard cases are amenable to surgical correction.

What can be done to prevent hypospadias

According to experts, anomalies of the urethra are laid in the early stages of pregnancy, and, the sooner, the harder would be redundant.

Therefore pregnancy should be planned to exclude, for example, the detrimental effect of alcohol, nicotine, drugs and so on embryogenesis. Prophylactic administration of folic acid and vitamin E reduces the likelihood of fetal abnormalities.

Do not plan a pregnancy immediately after the administration of oral contraceptives. It is better to wait a year, when the mother’s hormones will be restored.

Victoria Mishina, urologist, medical columnist