Wednesday, March 15, 2023

Hypospadias.. causes, symptoms and treatments for this congenital malformation of the penis

Congenital anomaly that only affects males:

Hypospadias is a birth defect of the penis. Update on the causes, symptoms and management of this anomaly.

Hypospadias is a congenital anomaly that only affects males: this malformation of the penis present from birth is not uncommon since it affects approximately 1 in 300 boys. In medical language, we also speak of hypospadias .

Hypospadias: what are the symptoms?

The word "hypospadias" is made up of the Greek root "hypo-" (which means "below") and "spade" (which means the opening).

In the case of hypospadias, the opening through which urine passes (known as the "urinary meatus") is not located at the end of the penis, but rather at the level of the penis, along the urinary canal. The hypospadias is thus characterized by:

  • a urinary orifice located on the underside of the penis (we speak of an ectopic meatus). In milder cases, the urinary meatus is near the top of the penis. In more severe hypospadias, the orifice is located in the center or near the base of the penis.
  • curvature of the penis (hypoplasia of the spongy bodies and skin tissue). When the penis is curved downwards, it is called chordee.
  • a foreskin open on the back of the penis (dorsal preputial apron).

Hypospadias: what are the causes?

To know. 5% to 10% of cases of hypospadias are familial. Approximately 20 babies out of every 10,000 are born with this birth defect. According to the French Association of Urology (AFU), the frequency of hypospadias has doubled since the 1970s.

The exact causes of hypospadias are not yet fully known. Scientists know, however, that there is talk of poor penile development between the 8th and 14th week of pregnancy. Several hypotheses are put forward today:

  • Exposure to estrogen-like endocrine disruptors. As the AFU explains, "several substances have been incriminated when they were absorbed during pregnancy, but with a low level of evidence: estrogens, progestins, antiepileptics, certain insecticides, fungicides, pesticides, phthalates, bisphenol A as well as than some phytoestrogen-rich vegetarian diets.”
  • Exposure to diethylstilbestrol (Distilbene) during pregnancy increases the risk of having a male baby with hypospadias by 20.
  • Hypospadias is more common in twin pregnancy "and often the smallest of the twins is affected" specifies the AFU.
  • An endocrine deficiency (androgens) or local growth factors.

Treatment: how to treat hyposdias? When to operate?

To know. Hypospadias is not a congenital malformation dangerous to health. However, it affects the appearance of the penis and its functioning. Some boys with hypospadias may have difficulty urinating while standing up. In adulthood, the location of the urinary meatus and the curvature of the penis can also affect sexual functioning.

The treatment of hypospadias is surgical:

surgery is thus recommended in order to avoid difficulties during urination (this refers to the action of urinating) and aesthetic problems. The aim is also to prevent difficulties during the sexual act and the risk of infertility.

To know. In case of hypospadias, surgery is usually offered when the child is 6 to 24 months old. "Intervening around the age of one means in particular the absence of memory of a gesture which can be painful" underlines the AFU. In 90% of cases, a single surgery is sufficient to correct this malformation. In very severe forms, the risk of re-operation reaches 50%.

Attention! While waiting for this operation, it is very important not to perform circumcision because the foreskin is used during the reconstruction. At the end of the operation, the penis looks circumcised.

The surgical intervention comprises several stages among which the straightening of the penis, the reconstruction of the urethra (urethroplasty) and the reconstruction of the glans. It requires hospitalization (usually a few days) and takes place under general anesthesia.

What are the potential complications?

Among the possible complications, we can point out the fistula (a communication comparable to a "tunnel" between the urethra and the skin) or the stenosis of the urethra (closing of the canal).

The little boy is seen again 4 to 6 weeks after the intervention by the surgeon, then 6 months and 1 year later. Then, a medical follow-up is organized with an appointment every 2 years until puberty to evaluate the functional and aesthetic aspects of the penis: thus, there must be no pain on urination, nor urinary infection. frequent; the stream of urine must be in line with the penis; the penis must be straight during erection.