Hypocrisy – causes, treatment, surgery

Hypocrisy is a congenital defect of the urethra where the opening of the urethra is between the glans and the perineum rather than at the glans. Hypocrisy may be an inherited defect as a result of environmental or endocrine factors. The condition is treated with surgery.

Hypocrisy – definition

Hypocrisy is a developmental defect that affects boys’ urogenital system. It is a congenital defect characterized by an abnormal position of the outer opening of the urethra – on the ventral surface of the penis instead of on the glans. The opening of the urethra is sometimes narrowed from birth, and its significant narrowing can lead to serious problems in the urinary tract, e.g. hydronephrosis.

Most patients have an enlarged foreskin on the dorsal side, while the glans or penis face downwards due to scar tissue located between the cavernous bodies. In severe forms of hypospadias, the bipartite scrotum or the underdevelopment of the penis may appear. Then the opening of the urethra is on the perineum in the folds of the split scrotum.

The incidence of hypospadias

The prevalence of hypospadias varies greatly. In male newborns, this is estimated to be approximately 1: 250 to 1: 350 live births. Statistics vary depending on geographic location. However, this type of malformation is most common among white people and children of Jewish origin. There is still no information about the inheritance of hypocrisy, but about 20 percent. cases it runs in families.

Hypocrisy – causes

The cause of hypospadias is the abnormal joining of the urogenital folds, which leads to the displacement of the urethral opening. Depending on the severity of this defect, we can distinguish hypocrisy, penile, perineum and scrotum.

Hypocrisy – symptoms

The symptoms of hypospadias include:

1. split foreskin,
2. flexion and shortening of the testicle,
3. no frenulum,
4. frequent curvature of the penis,
5. problems urinating,
6. frequent urination underneath,
7. underdevelopment of the foreskin,
8. large distance between the urethra and the top of the glans,
9. problems with urinating from a standing position,
10. problems during intercourse (in adult men who have not had surgery)
11. sometimes there is infertility,
12. delayed start of sexual initiation.

What are the side effects of hypospadias?

Apart from the fact that hypospadias causes deformation of the genital organs, there are other complications as well. The disadvantages associated with hypophysis include:

1. cryptorchidism,
2. inguinal hernia / testicular hydrocele,
3. sexual development disorders.

It is sometimes considered intersexuality, especially when one or both testes are misplaced into the abdomen or groin instead of the scrotum. Children should be very carefully diagnosed for hermitism or gonadal dysgenesis.

Hypocrisy – the division

Division of hypospadias is based on the location of the opening of the urethra. One of the most factual divisions is the one given by Barcat, who distinguished three groups of the position of the urethra:

1. front,
2. middle,
3. back.
4. In each of these groups, several items were additionally distinguished. This type of division is made in patients whose position is assessed during corrective surgery or in whom it is not bent. However, the most practical division is the one in which the following stands out:

1. acornid hypocrisy – is the most numerous group. The opening of the urethra is located on the glans between the groove and the apex. There are no problems with underdevelopment of the penis, while the foreskin is overgrown on the dorsal surface, and the glans can be bent. In the form of acorn hypospadias, we can observe a narrowed opening of the outer urethra, which should be diagnosed and treated at the newborn stage. Occasionally, there is a need for surgical treatment;
2. penile hypospadias – in this case, the opening of the urethra is located on the ventral surface of the penis, between the gastric groove and the penile-scrotal angle. You can get the impression of underdevelopment, because in most patients the penis is bent abdominally. In addition, this type of hypophysis includes forms where the opening of the urethra is located on the border of the penis and scrotum. In the penile form, other additional malformations often appear;
3. perineal hypospadias – this is the most severe form of the disease and is relatively rare. The external opening of the urethra is located in the folds of the split scrotum. In patients with advanced hypospadias, there are sometimes doubts as to the gender of the baby. In addition, there is an underdevelopment of the penis and bipartite scrotum. Perineal hyperemia should undergo specialist diagnostics: anatomical, hormonal and genetic.

Hypocrisy without hypocrisy – is a special form of this ailment characterized by the opening of the urethra at the top of the glans. The penis in this case is bent abdominally by the scarred tissue that is located between the cavernous bodies of the penis.

Hypocrisy – treatment

All types of hypospadias are treated surgically. Currently, there are many methods of plastic surgery that are being refined in detail.

Treatment of hypospadias is aimed at:

1. penis elongation,
2. creating the end section of the urethra,
3. straightening a short and curved penis,
4. giving the penis an appearance that does not differ from the norm,
5. ensuring proper sexual activity,
6. ensuring proper urination.

These treatments are performed on children. It is important for parents to pay attention to the structure and shape of their sons’ penis – an early diagnosis has the best chance of completing the operation with a satisfactory cosmetic effect.

There are still doubts about the age at which the procedure should be performed. There is a tendency to shift the age limit below the age of 2, but in some centers the procedure is performed already in the infancy period. Sometimes preoperative hormone treatment is also recommended – testosterone, placental gonadotropin or topical dehydrotestosterone ointment.

The missing section of the urethra is reconstructed from the skin of the penis. In the past, for this purpose, skin flaps taken earlier from other parts of the body were used. Nowadays, free flaps from the mouth and bladder are most often used (especially during repair procedures).

Find out how cystitis manifests itself

The treatment of hypospadias can be divided into multi-stage and simultaneous treatments. The latter are preferred more often, while multi-stage treatment is implemented in patients who have undergone and failed surgeries.

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