{"id":1854,"date":"2022-10-15T11:17:37","date_gmt":"2022-10-15T08:17:37","guid":{"rendered":"https:\/\/dregemeneroglu.com\/cocuklarda-peygamber-sunneti-hipospadias\/"},"modified":"2022-10-15T11:24:37","modified_gmt":"2022-10-15T08:24:37","slug":"cocuklarda-peygamber-sunneti-hipospadias","status":"publish","type":"post","link":"https:\/\/dregemeneroglu.com\/en\/cocuklarda-peygamber-sunneti-hipospadias\/","title":{"rendered":"Hypospadias"},"content":{"rendered":"
Hypospadias<\/span><\/h5>\n
<\/h5>\n
Normally, when boys are born, the hole where the urine comes out is expected to be at the tip of the penis. But sometimes in life, everything may not be as expected and this hole may be located lower than it should be, in the body of the penis, sometimes even lower in the root of the penis, or even lower, close to the anus. When this hole, which should be at the tip of the penis, is lower, we call it the “prophet’s sunnah” among the Turkish people, and “hypospadias” in doctor terms. If not treated properly, it can turn into a life-threatening problem.<\/span><\/h5>\n
<\/h5>\n
In this Pediatric Surgeon’s journal, I will tell you about hypospadias.<\/span><\/h5>\n
<\/h5>\n
While the baby is developing in the mother\u2019s uterine, there is no difference between boys and girls until the seventh and eighth weeks. In the eighth-ninth weeks, with the effect of androgen, which we can define as the male hormone, the transformation from the common structure to the male genital organ begins. If the baby does not have enough androgen stimulation, the common structure develops as a girl. However, if there is a suitable amount of androgen, the urethra formed in the penile body and the head of the penis unite, and at the end of the process, the foreskin wraps around the penis 360 degrees. Thus, around the seventeenth week, the formation of the penis is finished; growth and development continue until birth. At this stage, a pause may occur in the formation process which can cause the urinary canal to cannot be completely formed, the hole to remain at the root of the penis or below, or it cannot merge with the canal of the glans. In addition, instead of wrapping the penis, the foreskin remains like a hood on its upper part, which is called the “hooded preputium”.<\/span><\/h5>\n
<\/h5>\n
Let me explain it a bit simple without confusing you too much. As a result, when the development of the penis is impaired and hypospadias occurs, the urinary canal hole is not located where it should be, the penis is often facing downwards which is also called chordee, and the foreskin doesn’t wrap around the penis, it stays behind like a hood.<\/span><\/h5>\n
<\/h5>\n
Why does this happen?<\/span><\/h5>\n
<\/h5>\n
We don’t know exactly why. There are some risk factors. For example, increased maternal age, maternal diabetes, birth before 37 weeks, hypospadias in the father, smoking of the expectant mother, exposure to certain drugs, in vitro fertilization… The increasing incidence since the 1970s creates the impression that environmental factors may be at the forefront. It is accepted that it can be seen in one in 300-400 babies today.<\/span><\/h5>\n
<\/h5>\n
We can only diagnose hypospadias by physical examination. In 40-50% of babies, the hole is slightly below where it should be, in the glans or just below it. We can find the urine hole in the body of the penis, around 25-30% in the root of the penis, or 20% in the lower part of the scrotum.<\/span><\/h5>\n
<\/h5>\n
Again, we can first understand whether there is an anomaly that may accompany with physical examination. If there is no finding suggestive of sexual development disorder or if hypospadias is a type close to the tip, there is no need to perform ultrasonography in children with isolated hypospadias to investigate whether there is a problem in the kidneys because the kidneys previously develop from different embryological structures.<\/span><\/h5>\n
<\/h5>\n
We surgically correct the problem in the penis in children with hypospadias.<\/span><\/h5>\n
Of course, the questions start to come.<\/span><\/h5>\n
<\/h5>\n
Should all hypospadias be operated on?<\/span><\/h5>\n
<\/h5>\n
If the urine stream is downward, the child will not be able to pee standing up; if the penis is facing downwards, which will make sexual intercourse impossible in the future; if infertility can occur, we recommend surgery. For men who do not experience these problems, it can be done for cosmetic purposes only if desired. As a matter of fact, in a study of 56 men who had not undergone surgery, it was stated that all of them could pee standing up, did not experience infertility, and were satisfied with their appearance. We also share this information in cases with a hole in the glans, which looks like a double urinary hole, at the very extreme, which is approximately 10%.<\/span><\/h5>\n
<\/h5>\n
Can children with hypospadias be circumcised?<\/span><\/h5>\n
<\/h5>\n
As I just explained, the foreskin is not suitable for new-born circumcision, since the foreskin is asymmetrically hooded behind the glans. In very mild cases, sometimes I may encounter the request of removing the skin, ie circumcision, without repairing the hypospadias. From my personal experience, I do not perform circumcision in such cases. It is unclear what will happen in the future. Because we can use that foreskin for hypospadias repair, sometimes to make a tube, and sometimes to support the tube we just made so that there is no leakage.<\/span><\/h5>\n
<\/h5>\n
One detail should be noted here. There are rare cases where the foreskin completely covers the penis instead of being like a hoodie. Let’s say we started circumcising a new-born baby, we peeled the skin back and saw that the hole was not in place. What are we going to do? In such cases, circumcision can be continued because there are articles stating that it does not affect the success of future surgery. It is necessary to express well to the parents that hypospadias is not caused by circumcision.<\/span><\/h5>\n
<\/h5>\n
When should hypospadias be operated?<\/span><\/h5>\n
<\/h5>\n
Although, when we look at the literature, surgery is recommended from the age of 6 months and before the age of 2-3, I think that penis size is more important than age. If the six-month-old baby is very fat, the penis is deeply embedded in the prepubic adipose tissue, and the penis size, especially the glans, can be very small. There are publications stating that the small diameter of the penis head adversely affects the results of the surgery. It is known that the administration of hormones to enlarge the penis can increase the problems after surgery. Therefore, we can choose to operate in 9-10 months old. If he has a very serious hypospadias, a dual-stage surgeon was required; In other words, if we first bring tissue from the foreskin or oral mucosa and make a tube in the second session, we expect 6 months to pass. In the same way, if there is a leak from the tube we just made, that is, if a fistula has developed, we expect 6 months to pass for its repair.<\/span><\/h5>\n
How is the surgery process?<\/span><\/h5>\n
<\/h5>\n
We often do it as day surgeries. After we put the children to sleep in the operating room, we make the surgical repairs, wake them up and explain the care, and finally we send them home. The length of the operation may differ according to the type of hypospadias.<\/span><\/h5>\n
<\/h5>\n
After surgery, a probe is inserted into the penis. We put a double layer of cloth under the baby, and we can keep the dressing dry by pouring the probe into the outer cloth. In general, we open the dressing after 3-4 days and take the probe after 1 week.<\/span><\/h5>\n
<\/h5>\n
The incidence of problems after surgery varies according to the degree of hypospadias. In a study in which approximately 5700 children were evaluated, it is stated that the complication rate is 10% in cases where the hole is close to the tip, while these rates increase to 40% or even 50% as the penis root or below descends.<\/span><\/h5>\n
<\/h5>\n
The most common problems are stenosis at the end of the urine tube we will make, leakage from this new channel or the expansion of the new channel.<\/span><\/h5>\n
<\/h5>\n
Let’s finish another journal. Actually, there is much more to say. However, my goal is to make my videos and my writings in my website interesting for you to read and watch. I am aware that the longer it goes on, the less interest it will get. I hope I was able to give you the information that could help. You can find examples of the articles I referenced below.<\/span><\/h5>\n
<\/h5>\n
Click if like you want to watch the video<\/span><\/span><\/strong><\/a>, subscribe, follow me on Instagram<\/span><\/span><\/strong><\/a>, and stay happy.<\/span><\/h5>\n
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    \n
  1. \n
    Dodds PR, Batter SJ, Shield DE, et al. Adaptation of adults to uncorrected hypospadias. Urology 2008; 71:682.<\/a><\/span><\/h5>\n<\/li>\n
  2. \n
    Chalmers D, Wiedel CA, Siparsky GL, et al. Discovery of hypospadias during newborn circumcision should not preclude completion of the procedure. J Pediatr 2014; 164:1171.<\/a><\/span><\/h5>\n<\/li>\n
  3. Nguyen S, Durbin-Johnson B, Kurzrock EA. Reoperation after Hypospadias Repair: Long-Term Analysis. J Urol 2021; 205:1778.<\/a><\/li>\n<\/ol>\n
    Prof. Dr. Egemen Ero\u011flu<\/h5>\n

    January 2022<\/p>\n","protected":false},"excerpt":{"rendered":"

    Hypospadias Normally, when boys are born, the hole where the urine comes out is expected to be at the tip of the penis. But sometimes in life, everything may not be as expected and this hole may be located lower than it should be, in the body of the penis, sometimes even lower in the […]<\/p>\n","protected":false},"author":2,"featured_media":1745,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[35],"tags":[],"class_list":["post-1854","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog-en"],"yoast_head":"\nHypospadias - Prof. Dr. Egemen Ero\u011flu<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/dregemeneroglu.com\/en\/cocuklarda-peygamber-sunneti-hipospadias\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Hypospadias - Prof. Dr. Egemen Ero\u011flu\" \/>\n<meta property=\"og:description\" content=\"Hypospadias Normally, when boys are born, the hole where the urine comes out is expected to be at the tip of the penis. 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