CONGENITAL URETHRAL HYPOSPADIA IN INFANTS

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Relevance. Recently, negative statistics of the relative increased number of children's urogenital pathologies have been outlined. Hypospadias are the third most common after meatostenosis and phimosis.                                                                                                                              Goal. The study of hypospadias as a frequent pathology of male infants and the analysis of prospects for surgical treatment.                            Materials and methods. In the course of the study, an analysis of the scientific literature was carried out.Results. Hypospadias is a congenital pathology in which the urethra is not on the head of the penis, but on its lower surface. Hypospadias occur in 1 one boy out of 200. It includes cephalic, scrotal, stem and perineal hypospadias.Hypospadias occur due to a violation in the production of androgens in the placenta, a violation of the transformation of testosterone into dihydrotestosterone. It can also be caused by conception with the help of in vitro fertilization, taking hormonal drugs by the mother during pregnancy, heredity, adverse environmental factors.The cephalic form of hypospadias is the most frequent, occurring in 73% of cases in newborns. In this form, the opening of the urethra is located on the head, but closer than normal. It is diagnosed after birth by a surgeon or urologist when examining a newborn. The symptoms are not pronounced and there is a slight deformation of the cavernous bodies .The coronal form of hypospadias (okologolovataya). In this form, the outlet of the urethra exits under the coronal furrow (under the head of the penis). This form is accompanied by a pronounced deformation of the penis, due to the splitting of the foreskin, it takes the form of a "hood". Difficulty urinating occurs. The treatment is carried out surgically, the optimal age of the patient is considered to be from 6 to 18 months. During the surgical intervention, the restoration of the primary form of the penis is carried out, its curvature is eliminated, a part of the urethral spadiation of the penis trunk is recreated anew. The outlet of the urethra is located at different levels of the trunk. There is a significant deformation of the penis, the urine stream is directed downward. Treatment of this form must be performed in the first year of the patient's life. The treatment is carried out surgically and consists of the following stages: correction of penile deformity, surgical formation of the urethra, plastic surgery of the glans penis and reconstruction of the penis skin itself.Scrotal shape. The outlet of the urethra is located between the scrotum and the penis. There is an underdevelopment of the penis and splitting of the scrotum. In appearance, it resembles a swollen clitoris.The perineal stage. In this form, there is an underdevelopment of the penis, such as a small deformed penis, underdevelopment of the head, splitting of the head. The outlet of the urethra is located behind the scrotum and looks like a scrotum. The treatment is surgical, the optimal period is the age of the patient from 6 to 18 months. When performing surgical treatment, one should not forget about the aspects of cosmetology. That is, to create the right cavernous bodies, to get rid of excess skin, to normalize the excretory duct of the urethra.Treatment of hypospadias should be started in the period from 6 months to 3 years, since against the background of the patient's growing up, problems with sexual life appear, which are joined by complexes, neuroses and chronic stress. The treatment of this pathology in its various forms is aimed at achieving two goals: the formation of the missing part of the urethra with the formation of its external opening in an optimal anatomical position and the straightening of the penis by excision of connective tissue scars.Discussion.  During the study, it was found out that the most common form of hypospadias occurring in male infants is cephalic (about 73% of the total number of pathologies).                                                            Conclusion. The problem of hypospadias and associated issues in diagnosis and treatment, despite many domestic and foreign scientific papers, remains relevant. The issues of research, the choice of optimal tactics of surgical treatment, prevention of postoperative complications have not yet been sufficiently studied.

About the authors

Egor Zhanovich Dolzhikov

Voronezh State Medical University named after N.N.Burdenko

Author for correspondence.
Email: bubyke@gmail.com
ORCID iD: 0000-0002-3073-4449
https://vk.com/georg_13

student

Russian Federation, 10 Studentskaya str., Voronezh, 394036, Russia

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