Treatment In Patients with hypospadias

Definition

A congenital abnormality in which the external urethral meatus (pee hole) is located at the bottom of the penis and is located more towards the base of the penis than normal. Hypospadias is usually accompanied by abnormal shape caused by the existence of chordee penis and the penile skin at the back of a relative excess and the bottom is less.

Clinical Symptoms
* The glans penis shape is more flat and there is a shallow indentation at the bottom of the penis that resembles a urethral meatus externus
* Prepuce (foreskin) there is no bottom of the penis, accumulate at the back of the penis
* The existence of chordee, the fibrous tissue surrounding the meatus and extending up to the glans penis, felt harder than surrounding tissue
* The foreskin is very thin bottom
* The tunica dartos, fascia and the corpus spongiosum Buch no
* Can occur without chordee, if the location of the meatus at the base of the glans penis
* Chordee can occur without hypospadias so the penis becomes bent
* Often accompanied undescended testicle (testis does not descend into the scrotal sac)
* Occasionally accompanied by congenital abnormalities of the kidneys

Management
The goal in hypospadias surgery is that patients can urinate normally, normal penis shape, and allow normal sexual function. Expected outcome of surgery is a penis that is straight, symmetrical, and have the external urethral meatus in its proper place, namely at the tip of the penis. There are many variations of techniques, which are popular tunneling-Chaula Sidiq, Thiersch-Duplay, Dennis Brown, Cecil Culp.

* Sidiq-tunneling technique Chaula surgery two stages.
1. The first stage of excision of the chordee and could well be made that berepitel tunnel on the glans penis. Performed at age 1 ½ -2 years. Expected straight penis, but still in place meatus abnormal. Surgical wound closure using the dorsal prepuce and penile skin

2. The second stage performed uretroplasti, 6 months post-surgery, when the scar is tender. Incision made in parallel on each side of the urethra (urinary tract) to the glans, then the pipe is made of leather in the middle. Once the urethra is formed, the wound was closed with a skin flap from the prepuce drawn section side down, and met at the midline. Done 6 months after the first stage in the hope of the first operation scar has matured.

Engineering + Horton and Devine, performed a stage, performed in children with a larger penis that was big enough and with abnormalities hipospadi distal type (which is located lebig to the tip of the penis). Urethral mucosa and the flap is made from the skin of the back and the tip of the penis with the pedicle (foot) and then moved downwards.

Given the importance of the prepuce hypospadias repair to the base material, then the act of circumcision should be delayed and performed simultaneously with the operation hipospadi.

Epidemiology

In the U.S. occurs in every 300-350 babies born male life. The more proximal (closer towards the base) where the meatus, the more severe disorder and less and less frequency.

Cause

* Production of abnormal androgen
* Differences in sensitivity to the hormone androgen-related tissues, such as genital tubercle
* The hormone estrogen from the environment

Additional examination

Rarely performed additional tests to support the diagnosis hipospadi. Can be performed such as renal ultrasound examination and BNO-IVP remember hipospadi often accompanied by abnormalities in the kidneys.