There are two holes on the glans

The most vulnerable part of men is their genitals. If there is a problem with the genitals, it will cause problems in the family and work. Many children will also have these problems, such as foreskin being too long and hypospadias. Some parents reported that their children have two holes in the glans, which is a urinary system malformation in children and is relatively common in current clinical hospitals. This article introduces the causes and clinical manifestations of hypospadias, including examinations. Let's learn about it together.

Hypospadias is a congenital defect in which the male urethra opening is located abnormally. The urethra opening can be located on the line connecting the normal urethra opening to the perineum. Most patients may have a ventral curvature of the penis. Hypospadias is a common malformation of the urinary system in children. According to foreign reports, the incidence rate can be as high as 1 in 125 to 250 male babies.

Causes

In hypospadias, the penile fascia and skin fail to develop normally on the ventral side of the penis during the 8th to 14th week of pregnancy. Hypospadias may form when the urethral grooves are not fully fused. At the same time, the corpus cavernosum of the urethra is also incompletely developed, forming cords at the distal end of the hypospadias, which can cause penile curvature. Most cases of hypospadias do not have a clear cause, and most scholars believe that multiple factors are involved in the formation of hypospadias. A small number of cases may be caused by single gene mutations, while most cases reported in the literature are related to advanced maternal age, endocrine levels, ovulation-inducing drugs, anti-epileptic drugs, low birth weight babies, preeclampsia, and other environmental factors.

Clinical manifestations

(I) Hypospadias may have the following manifestations

1. Ectopic urethral opening

The urethral opening can occur anywhere from the proximal end of the normal urethral opening to the perineal urethra.

2. Penis curvature

That is, the penis bends toward the ventral side, and urination and sexual intercourse cannot be performed normally. The causes of penile curvature include incomplete development of the ventral side of the penis and axial shortening of the tissue.

3. Abnormal distribution of foreskin

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 of the foreskin is absent, and the entire foreskin is transferred to the dorsal side of the glans penis and piled up in a cap shape.

4. Splashing of urine during urination.

(II) Hypospadias can be divided into 4 types according to the anatomical location of the urethral opening.

1. Penis head shape

The urethral opening is located on the ventral side of the coronal sulcus and is usually slit-shaped. It is usually accompanied by only mild penile curvature and does not affect sexual life and fertility.

2. Penile type

The urethral opening is located on the ventral side of the penis from the coronal sulcus to the junction of the scrotum and penis, accompanied by the curvature of the penis;

3. Scrotal type

The urethral opening is located in the scrotum, often accompanied by scrotal fissures and severe penile curvature;

4. Perineal type

The external urethral opening is located in the perineum, the scrotum is split and underdeveloped, and the penis is short and curved, which is often misdiagnosed as female. Since the external urethral opening will retract to the perineum to varying degrees after the correction of the penile curvature, the method of classification based on the retracted position of the urethral opening after correction of the hypospadias has been accepted by many doctors in recent years. Children with severe hypospadias often have other associated malformations, including cryptic testis, inguinal hernia, hydrocele, prostatic sac, penoscrotal transposition, penile torsion, small penis, duplicated urethra, etc. A small number of patients may have combined anorectal malformations.

Check

Hypospadias is a malformation of the external genitalia, which is easily diagnosed based on typical clinical manifestations and physical examination. After confirming hypospadias, further examination is required to check for associated malformations. Severe hypospadias requires further urinary system examination, such as voiding cystourethrography, to exclude other urinary system malformations. When hypospadias is combined with bilateral cryptorchidism, attention should be paid to whether there is any gender abnormality. Examination methods include:

1. Physical examination: Observe the patient's body shape, body development, and secondary sexual characteristics; examine the external genitalia to see if there is a vagina; and palpate the surface texture and volume of the testicles.

2. Abdominal ultrasound.

3. Chromosome examination.

4. Urine 17-ketosteroid test.

5. Laparoscopy and gonadal biopsy.

treatment

Because hypospadias has caused the urethra to be abnormally positioned, the penis is bent, and the patient cannot urinate or have sex normally, surgical treatment is required. Surgery is to restore the penis's urination and sexual intercourse functions.

(I) Surgical goals

1. Complete correction of penile curvature;

2. The urethral opening is located in the correct position of the glans penis;

3. Form a normal forward urine flow during urination;

4. The appearance of the penis is close to normal, and normal sexual life can be carried out in adulthood.

(II) Timing of surgery

From the perspective of psychological development, there are two appropriate times for surgery.

1.6 to 15 months. The advantages include: children at this age do not have gender awareness and cannot realize that surgery is traumatic; treatment can be completed before the child starts school if treatment begins at this age; complications of short penis can be treated with medication; and healing is faster at this age.

2.3 to 4 years old.

At present, the surgical method is mostly selected based on the severity of hypospadias and whether it is combined with penile flexion. There are many methods for repairing hypospadias, which can be divided into one-stage repair method and staged repair method. Cases that can be repaired in one operation are mostly selected for one-stage repair method. When hypospadias is more serious or accompanied by deformity and penile flexion or cannot be repaired in one operation, staged repair method can be selected. One-stage repair method includes: one-stage repair of hypospadias by urethral extension, urethral reconstruction by scrotal longitudinal septum vascular cluster flap, urethral reconstruction by dorsal penis skin tube, and urethral reconstruction by foreskin flap transfer. The first stage of the staged repair method is to correct the penile curvature deformity, and the second stage of the surgery is urethral reconstruction. It is mainly divided into buried leather strip urethral reconstruction method, local flap urethral reconstruction method, skin graft transplantation urethral reconstruction method, bladder mucosa graft transplantation urethral reconstruction method, and oral mucosa graft transplantation urethral reconstruction method according to the source of the material for urethral reconstruction.

There are many surgical methods for hypospadias. So far, there is no ideal surgery that is suitable for all types of hypospadias. The surgical method should be selected based on the patient's age, the type of lesion, and one's understanding and experience of the surgical procedure. Regardless of the method used, complications after surgery may still occur. The most common surgical complications are urethral fistula (5-15%) and urethral scar hyperplasia and stenosis. Other complications include recurrence of penile flexion, urethral stenosis, urethral diverticulum, etc.