What Are the Different Methods of Hypospadias Repair?

Hypospasal repair is a male surgical procedure.

Repair of hypospadias

Hypospasal refers to the fact that men's urethral openings are not at the forefront of the penis, but are located below the glans, ventral side of the penis, root of the penis, or perineum. Often accompanied by penile curvature and testicular insufficiency (cryptorchidism), some boys have to urinate in squatting position, and it is more difficult to distinguish between men and women, causing great pain to the family.

Congenital hypospadias is caused by the incomplete fusion of urethral folds on both sides of the urethral groove in the embryonic stage, which causes defects in the distal urethra. In the part of the urethral defect, the lower urethra is often replaced by connective tissue or fibrous cords. This pathological change As a result, in addition to some defects in the urethra, the penis is deformed in two ways. The first is the ventral flexion of the penis, which cannot be straightened; the second is that the foreskin accumulates too much on the back of the penis, but the ventral side of the penis is insufficient. The so-called foreskin is eagle hat deformity. Therefore, if the hypospadias is slightly severe, because the penis is deformed from the ventral side, this deformity is more serious during erection, and it is difficult to perform normal sexual life; and because of a partial urethral defect, it is difficult to shoot semen into the vagina during sexual life, leading to Education.

1. The appearance of abnormal opening of the urethral opening.

2. The penis is short and bends to the ventral side.

3. Severe perineal deformities need to exclude both genders.

(A) Hormonal factors The hormones produced in the fetal testis affect the formation of male external genitalia, and their formation is completed around the 14th week of the embryo. And this development process needs the stimulation of dihydrotestosterone to complete. Dihydrotestosterone is converted from testosterone secreted by the fetal testis under the action of 5-reductase. Therefore, in the process of fetal penis formation, any testosterone deficiency, abnormality in the process of converting testosterone to dihydrotestosterone can lead to genital malformations.

(2) Genetic factors have a more obvious familial tendency for the occurrence of hypospadias. It has been reported that the rate of chromosomal aberrations in patients with hypospadias is significantly higher than in the normal population. Others believe that mutations in genes related to sex differentiation such as androgen receptor gene (AR) and sex determination gene (SRY) mutations are closely related to hypospadias.

(3) Environmental factors Some studies have found that the incidence of hypospadias is higher in fetuses who have used progesterone or other drugs in early pregnancy and fetuses conceived in winter.

1. If the penis is too small, apply male hormone therapy appropriately. After the penis develops, perform surgery.

2. For patients with urinary tract infection, the infection must be strictly controlled before surgery.

3. Wash the perineum with soap and water 3 days before the operation and apply chlorhexidine wet.

4. Check the position of the urethral orifice in detail, correctly estimate the position of the urethral orifice retraction after penis straightening, and measure whether the skin of the foreskin, penis, and scrotum is available. Through comprehensive judgment, decide on one or stage surgery and what kind of surgery.

1. Posture: Same as penis straightening.

2. Incision: Make two parallel oblique incisions around the urethral orifice on the ventral side of the penis, with a distance of about 1/3 of the penis circumference. The two incisions are inclined diagonally to the dorsal side of the penis to the coronary sulcus, which can slightly exceed the dorsal midline. Then they are connected together, and this is the skin flap C forming a skin tube.

3, penis straightening, urethral shaping: First make an additional incision along the coronary sulcus to make a flap A. Lift the A flap to reveal the fibrous band in the ventral center of the penis, completely remove it, and fully straighten the penis. Then insert the urethral catheter from the urethral orifice, separate the peripheral edge of the C flap, and wrap the urethral catheter to form a tubular tube with the wound facing outward. The suture is interrupted with 5-0 nylon or silk thread, and the knot is hit on the inside of the tube. Make it fall off by itself. Make a tunnel at the head of the penis, bury the distal end of the finished pipe into the tunnel, and fix the outer opening of the pipe with the wound edge of the penis head. Although the urethra thus formed is slightly curved, it does not affect the smooth flow of urine.

4. Close the wound: Separate the A and B flaps, and make an additional transverse incision in the coronary sulcus. Pull the flap toward the ventral center and make two rows of sutures (same burial urethroplasty). At the end of the operation, the urethral catheter was pulled out, a rubber sheet drainage strip was placed at the newly formed urethral orifice, and the penis was fixed on the abdominal wall with a pull line or thin steel wire.

1. Try to avoid water in the surgical department within 7 days after the operation;

2. Ensure that the surgical site is clean and prevent infection. If there is blood rash or secretions on the wound, wipe it with sterile saline;

3. After the operation, you can apply pressure to the local wound or cold pack with an ice pack, but the pressure should not be too large to avoid damage to the penis. If there is more than one bleeding and severe hematoma after surgery, you should return to the hospital in time for consultation;

4. Have a quiet and comfortable environment to rest after the operation. Do not watch TV or newspapers within 2 weeks after surgery. It is best to rest in a semi-recumbent position (higher pillow) during bed rest to avoid excessive fatigue of the penis or low head position, which may increase swelling of the wound;

5. The wound will be a little painful on the day of surgery, but it will gradually decrease over time. Patients should not rush to take pain tablets, because aspirin can aggravate wound bleeding;

6. Avoid eating irritating foods such as peppers;

7. Strictly follow the doctor's instructions to take medicine and return to the clinic.