HYPOSPADIAS AND EPISPADIAS
Hypospadias (Prophet Sunnah) is a congenital anomaly of the urogenital system that occurs as a result of the developmental failure of the urinary tract (urethra). In this anomaly, the urinary hole (urethral orifice) is located on the lower face of the penile body and at any point ranging from the far end to the back on the mid-axis, contrary to the normal position.
In this anomaly, the tip of the penis is in the form of a slit in the lower part and the foreskin is located only on the upper side. The penis is covered with a thin, shiny, unqualified skin covering that spreads from the abnormally located hole on the lower face to the tip of the penis. In this part of the skin, there is a groove in the middle axis. The foreskin is such that it covers the glans like a skullcap on the upper side.
Under the thin and shiny skin in front of the abnormal urinary opening, the important anatomical tissues that should normally be found have not developed, and instead of these, there are hard fibrous tissues that expand in the form of a fan from the meatus to the glans and prevent the erection of the penis. The fan-shaped pathological deformity formed in these fibrous tissues is called chordee or curvature and causes the penis to bend forward during erection. This deformity may be so severe as to prevent sexual intercourse. It also causes psychological problems.
Hypospadias is a very common congenital anomaly, occurring in 1 in every 300 – 400 male births. Undescended testis and kidney anomalies, hernias, and double urethral hypospadias are more common in patients than in the normal population.
Treatment age in patients with hypospadias is before school age. However, besides those who recommend it to be done at 1.5 – 2 years old, those who prefer 4 – 6 years old are the majority. We also find the age of 4-6 years appropriate in terms of timing, for reasons such as the penis reaching a sufficient size and the ease of cooperation with the child.
The important thing in the treatment of hypospadias is the repair of the urinary tract. It is very important that the tissue to be used for this purpose is elastic, thin and hairless. Therefore, the foreskin is the most suitable skin. Therefore, patients with all kinds of hypospadias should never be circumcised. Because a very important donor area is lost.
The treatment of hypopadias is surgery. Although more than 200 surgical methods have been described to date, there is no method that has been adopted by everyone, is easy to apply and is successful. The multiplicity of surgical methods applied shows how difficult this issue is. Although it is difficult to achieve complete success in the treatment of hypospadias, which requires great patience and meticulous work, the experience of the surgeon and the choice of the most appropriate surgical technique for the patient will increase patient satisfaction.
It is examined in two groups as early and late complications.
• Wound opening
• Fistula (leakage in the urinary tract)
• Meatal stenosis (stenosis in the outlet)
• Urethral stenosis (stenosis in the urinary tract)
Epispadias is a very rare anomaly that can be encountered in both men and women. Its presence together with exstrophy vesica (open bladder) is more common than its presence alone.
Isolated epispadias occurs in every 30 – 50,000 births. The male to female ratio has been reported as 4/1.
In epispadias, the penis is shorter and wider than normal and there is normal erection ability. There is an open groove or slit on the upper surface of the penis. The urethra is short, and there are usually fibrous bands around the groove that pull. Therefore, the flattened penis (spatulose penis) is pulled upwards towards the abdominal wall. Because of this withdrawal, sexual intercourse becomes difficult. In some cases it is even impossible. The foreskin is not developed.
Its treatment is surgery. There are different opinions about the most appropriate age for repair of epispadias anomaly. However, it is generally accepted that surgical treatment is performed in the preschool period.