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Hypospadias

Hypospadias

The urethra is the tube through which urine is excreted from the bladder. Urine passes from the bottom surface of the penis. Urethra opening (exo nozzle), is usually at the tip of the penile glans. 

“Hypospadias” is the situation in which the urethra ends at the underside of the penis instead of its end.

Urethra’s opening may be a bit below normal position (mild), or anywhere else in the same straight line, to the base of the scrotum (severe).

Usually the final end of the penis, faces “cobra head” with the foreskin (the skin of the penis), get a hooded appearance. This is due to the foreskin’s ubnormal development underside of the penis. It may also look like “tightening” of tissue in the lower side of the penis, called “chordee”. This causes the penis to be pulled down and not let it straighten. More severe the hypospadias is, the higher the chordee.

Most frequent problems include disorder to urination radius (even urination need in a seated position), and penis’ bending due to the existing chordee. Both lead to problems in appearance and sexual dysfunction in actual practice.

Hypospadias’ epidemiology rate is 1 in 300 children. As a disorder, it seems to occur more and more frequently. The reason for which the penis is not developed properly, it is not clear yet.
Penile development, while the baby grows into the uterus depends partially on male sex hormones such as testosterone. Testosterone effects on developing penis can not be excluded in some way. Though, it is not an inherited condition, it is frequent within family members.
Diagnosis is usually obvious from the penis’ examination. There is no other routine test. However, a small number of people with severe hypospadias (i.e. the urethral opening is at the base of the scrotum) may have other genital abnormalities. Therefore, chromosomic control (karyotype, microdeletions) is necessary.

Note: these syndromes are rare and most boys with hypospadias retain their masculinity and have no other abnormalities.

In cases that hypospadias is mild, urethra opening just below normal level and without penile bending, you may not need treatment.

However, in most cases, the treatment is surgical and can usually be done in one operation (one stage). In case hypospadias is more serious, two steps may be necessary to be taken. The surgery is usually done when the child is about 18-24 months.

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