Hypospadias
Hypospadias in the second most common congenital malformation in males after undescended testis. This anomaly is due to a disruption in the prenatal urethral development: the urethra opens on the ventral side of the penis rather than at the tip of the glans as it normally does. The malformation is often associated with ventral penile curvature and an abnormal distribution of the foreskin around the glans.
Although its causes are not fully understood, this condition is probably due to the interaction of genetic, endocrinological and environmental factors. It seems that babies with low birth weight present it more frequently, while the use of oral contraceptives appear to play no role in the development of hypospadias in the offspring. It also tends to be more common in monozygotic twins or in newborns conceived through FIVET/ICSI.
HOW MANY TYPES OF HYPOSPADIAS WE KNOW?
To date, hypospadias are classified based on the position of the urinary meatus. We recognize:
- Distal/anterior
- Intermediate/penile
- Proximal/posterior: urinary meatus is located in the penoscrotal, scrotal or even perineal area.
Distal hypospadias account for 70% of all cases, while the remaining 30% are proximal, often complicated by other concomitant alterations. In such cases, it is essential to exclude that it pertains to disorders of sexual differentiation.
The diagnosis of hypospadias is essentially clinical. The treatment of hypospadias is primarily surgical, with the aim of reconstructing the urethra to restore aesthetic and functional normality.
Difficulties in urination, penile curvatures that hinder sexual intercourse, fertility issues because of sperm deposition and discomfort are strong indications for surgery. Although this is generally performed early in life, the corrective procedure can be done at any age.
Currently, there are numerous surgical approaches for the correction of hypospadias. The choice of the technique is based on various factors, including the patient’s anatomy, the severity of hypospadias and the surgeon’s preferences. Long-term follow up is essential to monitor potential complications such as urethral strictures and penile curvatures.
Hypospadias can lead to serious psychological implications, especially in intimate situations. For this reason it is important that patients and their families receive appropriate psychological support to play down the emotional issues related to this condition.
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