Hypospadias

　　Hypospadias is the most common congenital anomaly of the urethra and external genitalia in male infants and young children. In recent years, the etiological studies on hypospadias can be summarized into several aspects.

　　1. Endocrine factors

　　In some cases, there are defects in the androgen receptor and 5α-reductase. Studies have shown that the response of androgen in hypospadias patients to human chorionic gonadotropin (HCG) stimulation is significantly lower than that in the normal control group, suggesting that the hypothalamic-pituitary-gonadal axis in hypospadias patients is abnormal.

　　2. Environmental factors

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

　　3. Chromosomal abnormalities

　　The rate of chromosomal abnormalities in hypospadias patients is significantly higher than that in the normal population, including autosomal and sex chromosome abnormalities.

　　4. Gene mutation

　　Hypospadias patients may have mutations in the androgen receptor gene, sex-determining gene, 5α-reductase gene, anti-Müllerian hormone gene, and CYP21B gene.

　　Severe hypospadias can cause the external genitalia of male children to resemble those of females. The disease can lead to shortening of the penis, sexual dysfunction, and psychological diseases such as low self-esteem, depression, anxiety, and even suicidal tendencies in adulthood.

　　Hypospadias is a congenital defect of an abnormal location of the male urethral opening, which can have various manifestations, as follows:

　　1. Abnormal location of the urethral opening

　　The urethral opening can appear at any location from the normal urethral opening near the perineum to the urethra.

　　2. Penile curvature downward

　　The penis bends ventrally and cannot urinate or have normal sexual intercourse.

　　3. Abnormal distribution of the foreskin

　　The foreskin on the ventral side of the glans penis is in a V-shaped defect due to the failure of fusion in the midline, the frenulum is absent, and the entire foreskin is turned to the dorsal side of the glans penis in a cap-like accumulation.

　　Hypospadias is a common congenital malformation of the reproductive organs in children, accounting for about 1/3 of pediatric urological patients. The occurrence of hypospadias in children involves a complex combination of genetic, tissue embryonic, pathophysiological, and environmental factors. Therefore, the most important factor in preventing hypospadias is prenatal care, avoiding factors that may affect the healthy development of the fetus, and preventing the possibility of malformed infants. Therefore, pregnant women should try to do the following during pregnancy:

　　1. Avoid catching a cold in the early stages of pregnancy.

　　2. Avoid getting close to pets.

　　3. It is best not to wear makeup during pregnancy.

　　4. Avoid mental stress.

　　5. Avoid drinking alcohol.

　　6. Avoid eating moldy food.

　　Hypospadias is a congenital malformation of the external genitalia, which can be easily diagnosed based on typical clinical manifestations and physical examination. After the diagnosis of hypospadias, further examination is needed to determine if there are associated malformations. Severe hypospadias requires urological examination to exclude other urological malformations. When hypospadias is accompanied by bilateral cryptorchidism, attention should be paid to the possibility of gender abnormalities. Specific examination methods include:

　　1. Physical examination. Observe the patient's body shape, physical development, and secondary sexual characteristics. Check for the presence of the vagina in the external genitalia.

　　2. Abdominal ultrasound.

　　3. Chromosome examination.

　　4. Urinary 17-ketosteroid determination.

　　5. Laparoscopic examination and gonadal biopsy.

　　Hypospadias must be treated with surgery, and it is required to be completed after the age of 1 and before the pre-school period. The incidence of postoperative complications is high, so high-quality postoperative dietary care is beneficial for the wound healing of the child, which is the key to improving the success rate of surgery. After surgery, the child should be fasting from food and water before the anesthesia wears off, and drink a small amount of boiled water 1 to 2 hours after the anesthesia becomes清醒. If there is no nausea or vomiting, the child can start with liquid food and gradually return to normal diet. The diet should focus on easily digestible, easily absorbable, and high-nutrition food, and appropriate supplements of fruits, vegetables, and roughage. Keep the bowels regular to prevent the wound from splitting due to strenuous defecation, which may affect wound healing. Encourage the child to drink more water to increase urine output and flush the urinary tract, preventing urinary tract infections.

　　Hypospadias generally requires surgical treatment. The one-stage urethroplasty for congenital hypospadias began to develop significantly in the mid-1950s, and the currently used surgical methods have reached more than 200, but there is no specific surgical method that can be suitable for all types of hypospadias. The goal of treatment is to make the patient's external genitalia appear as normal as possible, be able to urinate standing up, and be able to have normal sexual life after adulthood.

　　The age trend for the treatment of hypospadias is currently 6 to 18 months. Some scholars believe that the size of the penis of a 3-month-old baby is sufficient for urethroplasty. Completing the shaping surgery before school age has a smaller psychological impact on the patient, especially in recent years, the surgical technique for hypospadias has made significant progress, and the surgical methods have been continuously improved, which lays a foundation for improving the success rate of surgery and reducing complications. The following are several commonly used, effective one-stage surgical methods in recent years:

　　1. Urethral orifice anterior shift, glans formation (MAGPI).

　　2. Urethral orifice base vascular flap urethroplasty (Mathieu technique).

　　3. The island flap method.

　　4. Urethroplasty.

　　5. Horizontal (Duckett) or vertical (Hodgson)包皮岛状皮瓣尿道成形术.