Hypospadias

A PRESENTATION ON HYPOSPADIAS IN CHILDREN

1. HYPOSPADIAS

2. OBJECTIVES OVERVIEW DEFINITION INCEDENCE TYPES CAUSES RISK FACTORS SIGNS AND SYMPTOMS PATHOPHYSIOLOGY TREATMENT NURSING MANAGEMENT

3. OVERVIEW Hypospadiasis a birth defect (congenital condition) in which the opening of the urethra is on the underside of the penis instead of at the tip. The urethra is the tube through which urine drains from your bladder and exits your body. Hypospadias is common and doesn't cause difficulty in caring for an infant. Surgery usually restores the normal appearance of your child's penis. With successful treatment of hypospadias , most males can have normal urination and reproduction.

4. THE PENIS The penis is the male sex organ, reaching its full size during puberty. In addition to its sexual function, the penis acts as a conduit for urine to leave the body.

5. The penis is made of several parts: Glans (head) of the penis : In uncircumcised men, the glans is covered with pink, moist tissue called mucosa. Covering the glans is the foreskin (prepuce). In circumcised men, the foreskin is surgically removed and the mucosa on the glans transforms into dry skin. Corpus cavernosum : Two columns of tissue running along the sides of the penis. Blood fills this tissue to cause an erection. Corpus spongiosum : A column of sponge-like tissue running along the front of the penis and ending at the glans penis; it fills with blood during an erection, keeping the urethra -- which runs through it -- open. The urethra runs through the corpus spongiosum , conducting urine out of the body.

6. TYPES OF HYPOSPADIAS There are three kinds, depending on where the urethra opening is located: Subcoronal :-this is near the head of the penis. Midshaft : - this is along the shaft of the penis. Penoscrotal :-this occurs where the penis and scrotum meet, or on the scrotum (Renee. A. 2020) SUBCORONAL MIDSHAFT PENOSCROTAL

7. CAUSES Hypospadias is present at birth (congenital). As the penis develops in a male fetus, certain hormones stimulate the formation of the urethra and foreskin. Hypospadias results when a malfunction occurs in the action of these hormones, causing the urethra to develop abnormally. In most cases, the exact cause of hypospadias is unknown. Sometimes, hypospadias is genetic, but environment also may play a role.

8. RISK FACTORS Although the cause of hypospadias is usually unknown, these factors may be associated with the condition: Family history.  This condition is more common in infants with a family history of hypospadias . Genetics.  Certain gene variations may play a role in disruption of the hormones that stimulate formation of the male genitals.

9. Maternal age over 35.  Some research suggests that there may be an increased risk of hypospadias in infant males born to women older than 35 years. Exposure to certain substances during pregnancy.  There is some speculation about an association between hypospadias and a mother's exposure to certain hormones or certain compounds such as pesticides or industrial chemicals, but further studies are needed to confirm this. ( MayoClinic . 2020)

10. SIGNS AND SYMPTOMS Some boys with mild forms of hypospadias can have no symptoms from their hypospadias . If the hypospadias and/or chordee is not repaired, the child may have these issues as he grows: His urine stream may be hard to direct and control.  The penis may curve as he grows, causing sexual dysfunction later in life.  If the urethral opening is near or behind the scrotum, he may have fertility problems later in life.

11. PATHOPHYSIOLOGY Due to incomplete fusion of urethral folds along the middle Severity of condition depends on the location of opening The presence of opening near glans is known as Glandular Hypospadias The presence of opening near glans is known as Glandular Hypospadias

12. Presence of opening at corona is known as Coronal Hypospadias Presence of opening at shaft is known as Perineal Hypospadias

13. DIAGNOSTIC INVESTIGATION   A pediatrician can diagnose hypospadias based on physical examination. The assessment includes; Abnormal pattern of voiding Stream of urine may be deflected downward Child voids in sitting position in penoscrotal perineal hypospadias In glandular or coronal hypospadias child able to voids in standing position, by tilting the penis slightly upward.

14. MANAGEMENT There is no medical management for this defect. Surgery may be recommended for its correction and the goals of surgery are : To bring the urethral opening to the tip of the penis via a procedure known as urethroplasty . To straighten the penis. Circumcision of the foreskin should be avoided as this foreskin should be used for surgical repair. Surgery should be done preferably at the age of 6-24 months of age.

15. NURSING MANAGEMENT

16. PREOPERATIVE CARE Preparing patient’s for child surgery Psychological support should be given to the parent Consent form should be filled by the parents Vital signs should be checked Anemia should be corrected Any underlining medical condition should be treated before the procedure

17. POSTOPERATIVE CARE Monitor vital signs Catheter care should be given Put restraints so that child should not take out catheter or other tubing Urine examination should be done to rule out any infection Support and guidance of parents is very important ( Sheena.B . 2019).

18. COMPLICATIONS If hypospadias is not treated, it can result in: Abnormal appearance of the penis Problems learning to use a toilet Abnormal curvature of the penis with erection Problems with impaired ejaculation

19. REFERENCES https ://emedicine.medscape.com/article/1015227-overview https://www.ncbi.nlm.nih.gov/books/NBK482122/ https:// www.slideshare.net/Unit6lnh/hypospadias

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