Distal Hypospadias / Grade 2 - pre-and postoperative aspects

• In most cases the foreskin is split split ventrally. Sometimes the foreskin can be normal

· Penis turning around its one longitudinal axis is called penile torsion and it,s present only in severe cases.

There are over 300 surgical techniques described to correct hypospadias.After hypospadias surgery one may see several complications that may occur even after an apparently successful repair.
The place of the surgeon who performs ocasionally hypospadias repair tends to be taken by the “hypospadiologist”, a surgeon who understands the basic principles and various techniques used in hypospadias correction, and performs this type of intervention frequently enough to obtain consistently good results.

THE GOALSOF THE SURGICAL TREATMENT ARE :
To achieve a straigt penis with a uniform sized urethra that opens on the tip of the glans , without hair inside, a symmetrical penis, without excess skin or scars, a normal looking meatus (vertical split) , normal peing and normal erections. This goals may be achieved in the majority of the cases in one operation.

AT WHAT AGE CAN HYPOSPADIAS BE REPAIRED?
The surgical treatment of hypospadias can be successfully performed around the age of 12 to 18 months. In the 0-2 years age group penile reconstruction results are significantly better than after this age.

WHAT FORMS OF HYPOSPADIAS MUST BE REPAIRED ?
If the child has glanular hypospadias (grade 1), he does not require surgery for good function.The boy with this type of hypospadias will pee without any problems and will have normal erections and sexual function later, but even this minor form of hypospadias may affect the child psychologically, because the penis does not look normal Many adults with uncorrected glanular hypospadias do not want their partner to notice that their penis is “abnormal”.
If the child has distal hypospadias (grade 2) or proximal (grade 3), only surgery can ensure proper form and function of the penis.

Children with hypospadias may also have a very narrow opening requiring urethral dilation or enlargement surgery to avoid high pressures wich may influence bladder and kidney function.

PREOPERATIVE HORMONAL TREATMENT
Hormone therapy affects the penis not only, but the whole body, including bone growth, so should be used only in special cases: very small penis, small glans , marked penile curvature. Hormonal stimulation of the penis is useless in the first 6 months of life, due to the relative insensitivity of peripheral testosterone and it must be avoided after 5-6 years, because it can trigger an early puberty.

HOW IS THE NEW URETHRA CREATED ?
1. In some rare cases it is possible to mobilize the urethra and advancing it until the tip of the penis
2.From the ventral penile skin
3.From the foreskin
4. Combined: using the foreskin and the ventral skin of the penis
5. The penile skin from the lateral side of the penis
6. Using other tissues : obuccal mucosa, skin or bladder mucosa, retroauricular skin, vein.
To see technical details please go to www.hypospadias-surgery.com

SUTURE MATERIALS
In hypospadias surgery we use resorbabile sutures.Sutures generally disappear in a month. Sometimes resorption may take longer without affecting the normal process of
healing

DRESSINGS
There is a wide range of dressings used in hypospadias surgery. Currently many authors prefer not to use postoperative dressing, or use a compression bandage for 24-48 hours.Below we present our favorite dressing. With this dressing patient can safely raise a few hours after surgery, it is convenient and can be removed easily in the same time with the catether.

CATETHERS
Catether’s use in hypospadias surgery remains controversial. Some argue the requirement of using the probe bladder (a plastic tubuleţ ninth placed through the urethra into the bladder), or / and suprapubian catheter (a plastic tubuleţ placed through the abdominal wall into the bladder), others show that there is significant difference in the evolution of cases which was used probe transurethral bladder and those in which no probe was used.
Starting from the principle that the presence of the catheter causes irritation and inflammation of the urethra, increasing the risk of complications Prof Hadid leave no more than 2-3 days after surgery the catheter in the penis. In cases of glandular and distal hypospadias after two days the child can pee through the urethra new. In cases of proximal hypospadias Prof Hadid placed catheter in the bladder through the abdominal wall. The bladder catheter will remain in 10-14 days.

In our department patients are monitored on the basis of individual files. In the first months after surgery patients are seen weekly and then at 3 months and one year after uretroplastie; to those operated before school age, before starting school, during puberty and sexual activity