The male urinary tract is predisposed to hypospadias, a congenital defect that results in a displaced urethral opening. The urethral passage is not at the base of the penis, but can be anywhere on the lower side of the penis, from below the tip to just below the bottom or up to the scrotum. This disorder presents a range of challenges both medically and psychologically that affects a patient’s life. This is an article that aims to give you a clear picture of what hypospadias is, what causes it, how it affects you, how it is diagnosed, and what treatments are available.
Causes of Hypospadias
What precisely causes hypospadias is little-known. Yet it might be that a combination of genes and environment drives its evolution. Specific risk factors may include:
1. Family History: An Important Risk Factor.
Familial history is perhaps the strongest predictor of hypospadias. If a male relative has had hypospadias, especially if it’s the father who had it, there is a high chance that the condition will recur in future generations. Such a family history raises the question of whether the condition is inherited, and scientists are now interested in understanding how it works.
2. Maternal Factors: The Role of Pregnancy Conditions
Certain maternal factors during pregnancy can also influence the likelihood of hypospadias in the unborn child. Late maternal age and chronic diseases (particularly diabetes) have been identified as risk factors. Furthermore, maternal exposure to certain drugs – especially hormone therapy – and to alcohol or recreational drugs during pregnancy can increase the risk of hypospadias. Importantly, these considerations don’t cast mother-led behaviour as the direct source of hypospadias, but could act as risk multipliers in a complicated cascade of causes.
3. Hormonal Stressors: The Role of Androgens
Hormonal changes during foetal development can also alter the normal structure of the urethra. Abnormal levels of androgens, the male sex hormones, have been linked to changes in normal genital development. This hormonal influence points to the necessity of a controlled hormonal environment to maintain adequate anatomical growth throughout the development of the foetus.
4. Genetic Mutations: Recent Findings in Hypospadias Science
New genetic discoveries have identified several genetic mutations that could increase the likelihood of hypospadias. They represent an exciting target for future research, because knowing about these genetic traits can help us understand the underlying biological mechanisms responsible for the disease. This rising body of research points toward a possible transition in the epistemology of hypospadias towards more tailored care and counselling for families affected.
Hypospadias does happen in 1 in 200-300 live male births, but you need to remember that it’s not due to anything the mother did or didn’t do while pregnant.
Types of Hypospadias
Hypospadias is divided into categories according to the position of the opening in the urological tract:
Glanular Hypospadias: The cranial space is located at the end (glans) of the penis.
Coronal Hypospadias: Opening at the corona, between the glans and shaft.
Mid-shaft Hypospadias: The urine outlet is located at the shaft of the penis.
Penoscrotal Hypospadias: The urinary puncture occurs at the corner of the penis and scrotum.
Perineal Hypospadias: The piercing hole is located in the perineum, under the scrotum.
Symptoms and Diagnosis
The main symptom of hypospadias is the dysfunctional position of the urethral aperture. Other associated symptoms may include:
Curved Penis: Sometimes called chordee, this condition may be seen in some hypospadias patients, and causes an abnormal penis curve that can interfere with sexual function later in life.
Poor Urination: Depending on the severity and location of the urethral opening, some babies are unable to urinate in a straight line.
Paranormal foreskin: The foreskin is often irregular, creating a partial circle at the penis glans.
It is possible to diagnose hypospadias at birth by physical examination. Urologists or paediatricians will typically evaluate the location of the urethral opening and observe any associated changes. An advanced diagnosis could involve imaging studies, especially if structural issues are suspected.
Diagnosis of Hypospadias
Hypospadias is typically diagnosed within days of birth, during a routine physical examination. Pediatricians or urologists will examine the baby’s internal organs carefully. No imaging is often needed because the disease can be diagnosed from the outside through visual inspection.
During the exam, the doctor will also check for any concomitant abnormalities, including undescended testicles or chordee (curvature of the penis), commonly seen in hypospadias. What type of hypospadias you diagnose will determine what will be treated in the future.
Treatment Options
Hypospadias is usually treated surgically, especially when the child is between 6 and 18 months of age. It typically requires surgery to correct the dysplastic position of the urinary aperture and any complications that result from chordee.
Surgical Procedures
The objectives of surgery are:
Replace the urinary hole with the penis’s glans.
Repair any curvature (if present),
Build a functional and acceptable penis.
Operative approaches, though different depending on the form and severity of hypospadias, include:
Urethroplasty: Reconstructive surgery that involves moving and re-positioning tissue to create a new urinary passage.
Glanuloplasty: Surgical reconstruction of the glans after the urinary incision is moved.
Chordee Resurfacing: Corrections are performed for severe curvature in the penis.
Post-operative Care
Parents should always keep a close eye on their child’s recovery after surgery. Standard care includes:
Keep the surgical site dry and clean.
Administering prescribed pain relief,
Make frequent post-operative visits to assess recovery and urinary function.
The majority of children recover completely from the surgery. But some children might need further surgeries if the first surgery doesn’t provide the results they want.
Long-term Outlook
The survival rate for the vast majority of hypospadias children is excellent. After surgical repair, children usually live a normal life, without any major side effects of the disorder:
Normal Urinary Function: Typically, the majority of boys will have normal urinary function after surgery.
Psychosocial Impact: Young people may be initially scared about their condition, but when managed effectively, they can regain normal sexual function and fulfillment as adults.
This requires close contact with healthcare providers so they can monitor for problems or complications that may arise during the child’s development.
Conclusion: Hypospadias
Hypospadias, although a fairly common congenital disease, is alarming for parents. But diagnosis, surgery and control ensure that most boys with hypospadias are treated appropriately and are able to live healthy, productive lives. The more research done into the causes and risk factors of hypospadias, the better it can be identified and managed so that future generations are better off. If you have any questions about your child’s urinary tract, it is advisable to consult with a professional medical doctor.
