Doctor: Congenital hypospadias is not only due to incomplete fusion of urethral folds on both sides of urethral sulcus in embryonic period, resulting in distal urethral defect. In urethral defect, hypospadias is often replaced by connective tissue or fibrous cord. Due to this lesion, the penis has been deformed in two aspects except partial urethral defect. One is that the penis bends to the ventral side and cannot be straightened; Second, the foreskin on the back of the penis accumulates too much, while the ventral side of the penis is insufficient. The so-called foreskin is eagle hat deformity. Therefore, for patients with mild and severe hypospadias, because the penis is ventral flexion deformity, this deformity is more serious during erection, and it is difficult to have a normal sexual life; Due to partial urethral defect, it is difficult to inject semen into vagina during sexual life, leading to infertility.
Guidance: it can be corrected by one-stage plastic surgery or staged plastic surgery: in the first stage, the penis curvature is corrected, and the foreskin is transferred from the back to the abdomen to provide conditions for urethral reconstruction. Reconstruction was performed 6 months after the first operation. The ventral prepuce of penis is used to construct a new urethra, which is open at the head of penis. Successful operation can realize vertical urination and delivery in adulthood.
To explore the specific causes of hypospadias.
The cause of hypospadias is a polygenic genetic disease with a certain family tendency. (a) the factors leading to congenital hypospadias mainly include:
1. Genetic factors: Genetic factors are the most common causes of hypospadias.
2. Endocrine disorder: Modern medical research has found that hypospadias is mainly related to the lack of testosterone in the body, the decline in quality, and the lack of enzymes such as steroid oxidoreductase during synthesis.
3. Environmental factors: A large number of epidemiological studies show that some chemicals in the environment can obviously interfere with the development of urethra, and endocrine disrupting factors can interfere with the hormone signal system in the human body, leading to the abnormality of endocrine feedback regulation system.
4. Drug interference: When the mother took antiepileptic drugs in the first trimester of pregnancy, the urinary system abnormalities increased significantly, and sodium valproate was mainly related to hypospadias and limb shortening.
5. Chromosome abnormality: The chromosome aberration rate of hypospadias patients is significantly higher than that of normal people, including autosomal aberration and sex chromosome aberration.
6. Gene mutation: Clinical studies have found that there may be mutations in androgen receptor gene, sex determination gene, 5- reductase gene, anti-Mullerian hormone gene and CYP2 1B gene in patients with hypospadias.
(II) Pathogenesis During embryonic development, the development and fusion of urogenital groove on the ventral side of penis are influenced by pituitary gland and androgen. If androgen is insufficient, it will hinder the fusion of folds on both sides of urogenital groove, resulting in urethral abdominal wall defect, and the urethral orifice will be behind the normal urethral orifice on the ventral side of penis, resulting in hypospadias. According to the position of urethral orifice, hypospadias can be divided into four types: penis head type, penis type, penis scrotum type and perineum type. Among them, penis head type and penis type are the majority.
No matter what kind of hypospadias it is, it is necessary to operate and grasp the best operation opportunity.
According to the reproductive plastic surgeon of Congtai Chinese Medicine Hospital in Handan City, under normal circumstances, at the seventh week of embryo, the urethral fold wall gradually merges into a tubular urethra from the proximal urethra to the glans. This process depends on the androgen secreted by the gonad of the embryo, and also on the reaction of the urethral groove and plica wall of the embryo to cold ketone. Hypospadias is caused by the blockage of urethral wall to form a tube. In addition, the interstitial tissue at the urethral orifice is underdeveloped, forming a fan-shaped fibrous cord that surrounds the urethral orifice and extends into the glans penis, thus causing the born child to suffer from hypospadias. Hypospadias is formed in the mother. After birth, it is impossible to have any effect with drugs, physics and other methods. Only surgery is the only way to solve all kinds of hypospadias.
However, some parents think that children are too young for surgery, but the best time for surgery is 6- 18 months. Eight months ago, the penis had not yet formed. If it is repaired at this time, it will basically not affect the normal development of the penis. If you are old, some penises will bend and develop too little, which has a great influence on married sex life. Moreover, when the child is 3 years old, he has the ability to distinguish between sexes. As he grows older, his psychology will be affected to varying degrees. The older you get, the heavier your psychological influence is, and some of them directly form mental illness. Moreover, after 6 months, the risk of anesthesia is close to that of older children and adults.
In addition, early surgery can also free family members from long-term anxiety, and cheerful parents will be more conducive to children's physical and mental health. Reproductive plastic surgery experts in traditional Chinese medicine hospital reminded parents that they must pay attention to the best treatment opportunity for children with hypospadias and take them to the hospital for surgery in time.