What are the symptoms of hypospadias?

When hypospadias occurs at the urethral opening, the patient himself will actually feel very uncomfortable. If it is not treated or handled for a long time, the wound may become inflamed and lead to other diseases. Common symptoms of hypospadias include curvature of the penis, ectopic urethral opening, etc., which will also have relevant effects on the patient himself.

Clinical manifestations

Typical clinical manifestations of hypospadias are as follows:

Ectopic urethral opening

The urethral opening can appear anywhere from the proximal end of the normal urethral opening to the perineal urethra. Part of the urethral opening is narrow, and its distal end is the urethral plate.

Curvature of the penis

The penis is curved ventrally. Only 35% of hypospadias are accompanied by obvious penile curvature, and most of them are mild. The angle between the glans penis and the longitudinal axis of the penis shaft is used to classify penile curvature as mild (35°). The latter two have difficulty having sexual intercourse in adulthood. The main causes of penile curvature are the hyperplasia of fibrous tissue of the urethral plate, the lack of various layers of subcutaneous tissue on the ventral side of the urethra of the penis, and the asymmetry of the dorsal and ventral sides of the corpus cavernosum of the penis.

Abnormal foreskin distribution

The foreskin on the ventral side of the glans penis fails to fuse in the midline, so it presents a V-shaped defect, the frenulum is absent, and the entire foreskin is transferred to the dorsal side of the glans penis and accumulates in a cap-shaped manner.

Other related abnormalities

Other associated abnormalities include cryptorchidism (7% to 9%), inguinal hernia (about 12%), and hydrocele (9% to 16%). The incidence of inguinal hernia is similar in patients with anterior, middle, and posterior hypospadias, but cryptorchidism is more common in patients with posterior hypospadias. Male infants with both hypospadias and cryptorchidism should be evaluated for the possibility of hermaphroditism, even if their external genitalia are obvious. Prostatic cysts occur in severe hypospadias and may be a relic of incomplete regression of the paramesonephric duct or incomplete masculinization of the urogenital sinus. Some patients may have scrotal transposition, penile torsion, micropenis and duplicated urethra, and very few patients may have anorectal malformations.

Disease treatment

There are more than 300 surgical methods for hypospadias, but there is still no satisfactory procedure accepted by the majority of urologists. The cure criteria for hypospadias are that the urethral opening is located in the correct position of the glans penis, the curvature of the penis is completely corrected, the penis looks close to normal, the patient can urinate while standing, and the patient can have a normal sexual life in adulthood. The surgery should be performed between 6 and 18 months to relieve the mental stress on parents and children. The surgical method is selected based on whether there is concurrent penile curvature.

Treatment of hypospadias without chordee or correction of chordee by tightening the tunica albuginea on the dorsal side of the penis without cutting the urethral plate:

① Glans and coronal sulcus type: The MAGPI technique can be used. The advantage of this technique is that the urethra is placed deeper in the glans penis and an elliptical (cleft-like) wide urethral opening can be obtained, making the appearance of the urethral opening more satisfactory. The main disadvantages of this technique are posterior displacement of the urethral opening and stenosis of the urethral opening.

② Patients with coronal sulcus, subcoronal sulcus type and urethral opening located in the front 1/3 of the penis: The urethral opening base flip-flap technique (Mathieu technique) can be used. This procedure can also be used for patients whose hypospadias repair surgery has failed.

③Hypospadias at the penis body and base: Onlay island flap or Snodgrass urethroplasty can be used. The onlay island flap foreskin graft extension urethral plate has a good correction effect in the treatment of painful penile erection and is an effective surgical method that can be used for patients with primary hypospadias with severe penile curvature. Snodgrass urethroplasty combined with the use of a ventral basilar vascular subcutaneous tissue flap can improve postoperative penile cosmetic satisfaction and make the surgical procedure easier.