Treatment of hypospadias abroad
Hypospadias is a congenital defect of the penis (phallus, tentum) structure that is manifested by a misplaced urethral vent and chordee. Hypospadias is a pretty common phenomenon which is detected in 0,5% of newborn boys. It is only possible to treat this condition with the help of surgery.
Causes of hypospadias
Mainly, certain causes of hypospadias remain unknown. These canbe:
- Chromosomal or genetic abnormalities, e.g. there are more than a hundred syndromes that manifest itself with hypospadias
- Endocrine disorders like androgenic hormones deficiency caused by a iatrogenic intervention (administration of female sex hormones during pregnancy)
- Malformation of the embryonic development due to external factors like toxic chemicals
- Hereditary background accounts for 15% of all hypospadias cases
Symptoms of hypospadias
Hypospadias can be defined visually during patient’s exam. Its clinical signs may vary relying on the form of disease.
- Granular shape means that urethra opens in the area of the penile frenulum; the preputium or foreskin is absent from one side and hangs in an apron from the other side. Tentum form is usually normal, though the head of the penis can be tilted down. Besides, the urethral structure makes urinating complicated.
- Stem shape means urethra opens on the surface of the penis stem and the organ’s shape is deformed. Penis can look like a hook, especially when erected. A patient is forced to pull the penis up to the stomach for urinating. The stem shape leads to a painful erection as one ages, if it is not treated. Sexual intercourse is possible, but fertilisation will be complicated as ejaculation comes out of the misplaced urethral vent and doesn’t enter the vagina.
- Scrotal shape presupposes urethral vent location on the scrotum which is split and looks like large vulvar lips. Penis is significantly deformed if a patient has this type of hypospadias. A patient is able to urinate only in the sitting position and sexual intercourse is impossible.
- Perineal hypospadias means penis is completely deformed and makes its hard to verify the patient’s sex. Scrotum is split up and a patient can sometimes have a rudimentary vagina while penis looks like a hypertrophic clitoris. This type of hypospadias is often combined with cryptorchidism.
- Chordee without hypospadias (CWH or congenital penile curvature) means that the urethral vent is located at the right spot, but the penis is deformed due to the bands of fibrous tissue in its stem. Urethra is hypoplastic and is two times shorter than cavernous bodies. A patient can experience painful erection however intercourse is impossible in this case.
Diagnostics of hypospadias
Normally, hypospadias is easy to diagnose while examining patient’s reproductive organs, but there are additional techniques that help to clarify the nature of the malformed penis structure like:
- MRI of the pelvic organs
Hypospadias is often just one of many chromosomal abnormalities. Thus, patients are recommended to do karyotyping to determine the number and structure of chromosomes in the cells.
Karyotyping is obligatory if hypospadias is diagnosed together with cryptorchidism (undescended testicles) or other signs of chromosomal and genetic syndromes. Moreover, the procedure verifies the patient’s sex as hypospadias since it is sometimes misdiagnosed in girls suffering from hypertrophic clitoris.
Treatment of hypospadias abroad
Surgery is the only way to deal with hypospadias and several goals must be reached in the course of surgery:
- Correction of cavernous bodies to ensure a normal erection
- Creation of the urethra which is formed from tissues devoid of hair follicles, without strictures (contractions) having normal blood supply
- Formation of the longitudinal location of the meatus (urethral vent) and its placement to the top of the head of the penis
- Ensuring a normal process of urination: without difficulties, urine spays etc
- Providing a good aesthetic effect, so that in the future the patient could have a full sexual life
Patients undergo surgery at the age of 6 months to 1, 5 year old. This age is the most optimal time to perform an operation as cavernous bodies’ size is still small and stock of plastic material (primarily the skin of the penis) already allows for successful urethroplasty. In addition, surgery is not likely to damage the patient’s mental condition at such a young age. Older kids might develop an inferiority complex after the surgery and recovery.
Different clinics apply various types of surgeries. Right now, there are more than 200 kinds of operations that can be used for hypospadias treatment.
Choice of surgical techniques is made relying on:
- Clinical case (type of hypospadias)
- Age and patient’s overall health as there can be some other defects in the structure of the genitourinary system
- Hospital’s abilities as certain operations require advanced equipment, hence if you can afford to, it is wiser to undergo surgery in German hospitals due to the expertise and experience.
Autologous tissues taken from the penis or from other body parts and also tissue engineered products can be used in course of surgery to fix deformed anatomic structures. A surgeon does his best to reach all the goals during a single intervention, though some patients may require several consecutive operations.
Latest hypospadias treatment techniques
The aim of hypospadias treatment is same as a hundred years ago. However, today we have a lot more possibilities. German hospitals, in particular, actively implement latest developments of tissue engineering.
This means, that a small skin flap of 1 to 3 square centimetres is obtained from a patient and sent to the laboratory. Several weeks later the flap turns into a three-dimensional cellular structure fixed on a biodegradable matrix. The urethra is formed from the obtained dermal equivalent during the surgical operation.
Normally, tissue engineering is used for the scrotal and perineal urethroplasty. This enables :
- Solving the problem of autologous (own) plastic material deficiency, especially in early childhood
- Improving the aesthetic effect (a smaller amount of plastic material is taken from a patient)
- Reducing the risk of complications, especially hair growth from the newly formed urethra
Prognosis for hypospadias
A number of factors predispose the illness’s outcome. First of all, are causes of hypospadias, presence of concomitant defects in the structure of the urogenital system, as well as the quality of surgical treatment.
Prognosis is generally favourable as for restoration of the penis function and a patient will be able to urinate and enjoy sexual intercourse.
Patients who are residents of countries with poor healthcare systems are recommended to use medical tourism to undergo surgery in one of the German hospitals. This is vital because:
- Treatment results completely differ from country to country and medical institutions. Probability of restoration of penis function may vary from 75 to 95% after a surgery.
- Top hospitals ensure better aesthetic effect. This greatly improves one’s self image and sexual confidence.
- Best hospitals in the world implement the latest ways of treatment and it is possible to use the tissue engineered products for hypospadias treatment in children.
Hypospadias treatment is dangerous with a high risk of various complications like urethral stricture, fistula, and curvature of the penis. It can reach 50% in some health facilities. German clinics are known for a low likelihood of complications.