Hypospadias is disorder of external genitalia, which is uncommon at the ratio of 3:1000 people. The problem occurs when the urethral groove is incompletely closed on the penis underside. Usually, penis has dual roles. The first role is to give a urine pathway from the bladder and the second role is to enable the semen to get into the vagina. These two roles are well done, when urethral opening is regular and normally positioned at the normal place of head of the penis.
The causes can be a genetic cause or testosterone altered synthesis. Sometimes an receptor anomaly for the testosterone is the cause for the condition. Usually this condition is examined as a part of the physical examination done for the new born. When such condition is occurred, penis tip is not covered by the foreskin completely, and urethra opening is found near penis underside from the base to tip.
Male hypospadias is treated for several reasons and is conducted in full term or healthy boys, who are in between 3 months to 18 months. However, the repair can be performed also in childhood and sometimes possibly in the adulthood. Sometimes treatment for testosterone hormone is done before the surgery in case the opening is proximal.
The surgery is done to make the penis to straight to normal position having urinary channel at the head tip ends of the penis. The surgery is performed in four steps.
- Straightening the shaft
- Creation of the urinary channel
- Positioning the opening of the urethral in the head
- Reconstruction or circumcision of the foreskin
The surgery for hypospadias repair takes 90 minutes to 3 hours. It is done usually in stages. The surgery is usually performed with spinal anesthesia or general anesthesia. Urologists perform certain tasks during the surgery. They straighten the shaft separately before the urinary channel is constructed.
Hypospadias is done in first degree, second degree or third degree. First degree is a mere cosmetic defect, in which there is hardly any effect on the function. However, in certain cases, like the direction of the stream of the urine is the exceptional condition in the first degree. If it is not corrected the following second degree or third degree will make the urination to become messy, and may create the problems related to the fertility. Sometimes it may interfere with the erections. In some countries, especially in the developed countries, most of the hypospadias repair surgery is performed during the infancy itself. Most of the time, first degree and second degree surgical repair is successful, when performed in one procedure itself. The same procedure is usually done by plastic surgeon or pediatric urologists during the year of individual’s life.
Before the surgery is performed, sometimes it would be necessary to give human chorionic gonadotropin injection or testosterone injections, in case the penis is found very small. If the hypospadias is severe, multiple procedures may be required and sometimes mucosal grafting is also required. It is important to avoid circumcision before the repair is performed.
For the hypospadias repair, many of the surgeons prefer the fresh repair to be not used immediately, by the patient. After the surgery, for the first few days it is connected with a small catheter, which directly connects to the diaper. So, the patient does not need to urinate through the fresh repair. While the catheter has been connected, antibiotics and also antispasmodics for bladder are given.
After the surgery is performed, the schedule for the follow up visits is usually dependent upon the urologists.
Cost of Male Hypospadias Treatment
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