What causes penile hypospadias?

Hypospadias is a relatively common physical disease, especially in men. Men with hypospadias will not only easily affect their normal life, but also easily lead to some health problems. There are many reasons for male hypospadias. Generally, this is caused by congenital malformations and requires timely treatment.

What causes penile hypospadias?

Causes

1. Environmental factors: Some studies have found that the incidence of hypospadias is higher in newborns who have used progesterone to maintain pregnancy in early pregnancy. At the same time, some studies have shown that the levels of estradiol and estrone in patients with hypospadias increase. These studies suggest that estrogen has an antagonistic effect on androgens.

2. Endocrine factors: some cases have deficiencies in androgen receptors and 5α-reductase. Studies have found that the androgen response of patients with hypospadias is significantly lower than that of normal controls, suggesting that the hypothalamus-pituitary-gonadal axis of patients with hypospadias is abnormal.

3. Chromosomal abnormalities. The chromosomal aberration rate in patients with hypospadias is significantly higher than that in the normal population, including autosomal aberrations and sex chromosome aberrations.

4. Gene mutation. It was found that patients with hypospadias may have mutations in the androgen receptor gene, sex determination gene, 5α-reductase gene, anti-mullerian hormone gene, and CYP21B gene.

Complications

The main complications of hypospadias are urinary fistula, stenosis, skin flap necrosis, infection, etc. The main causes of serious complications after urethroplasty are incorrect surgical method design, improper intraoperative operation, tissue ischemia and necrosis, suture tension, local infection, and poor postoperative urine drainage. Among them, urinary fistula and urethral stenosis are one of the most common complications after hypospadias repair surgery.

Prevention of serious complications after hypospadias surgery lies in:

① Design a reasonable surgical method based on the degree of hypospadias deformity and the development of the penis, and try to use pedicled tissue with good blood supply to replace the urethra. For perineal hypospadias, it is not necessary to insist on completing the surgery in one stage. Sometimes staged surgery can achieve more satisfactory results;

② Strictly follow the principles of plastic surgery, move gently, dissect carefully, protect tissues, stop bleeding seriously, fully correct the curvature of the penis, ensure good blood supply to the formed urethra and the ventral skin of the penis, and accurately match the tissues;

③ Strengthen postoperative care, ensure that the drainage tube is unobstructed, clear the neourethral secretions at any time, use antibiotics reasonably, and give older children appropriate sedatives or estrogen to prevent postoperative penile erection;

④ Pay attention to postoperative follow-up, strengthen contact with the parents of the child, and understand the changes in the child's urination after discharge. If the urine stream becomes thinner or even drips, the surgeon should promptly dilate the urethra. If the child is uncooperative, it should be performed carefully under intravenous anesthesia to avoid urethral damage and aggravate urination difficulties. If the dilation is not smooth and blood flows out of the urethral orifice, suprapubic bladder puncture and fistula should be performed if necessary to temporarily divert urine.