In this video, Dr. Koushik Herle, Consultant - Paediatric and Neonatal Surgeon at Manipal Hospital Sarjapur Road, Bangalore.

hypospadias-i-dr-koushik-herle-i-mhsr

Hypospadias I Dr. Koushik Herle I MHSR

and a pediatric urologist at manipal hospital sarjapur road I'll be talking about a condition called hypospadias hypospadias is a condition which is exclusive to boys it's a condition where the uretra that is the tube which connects the bladder to the exterior where it travels through the penis is abnormal the abnormality here is where it opens on the under surface of the penis the opening of the Ural uh tube is not at the tip but on the under surface this is an image which shows the normal urra and the hypospadias urra you can notice that the uretra which is the tube carrying the urine from the bladder to the exterior normally opens at the tip of the penis but in hypospadias it opens on the under surface or the anterior surface of the penis in hypospadias it is not just about the urra but also the surrounding tissue which are also underdeveloped so the four skin which should have been throughout as in all around the pennis is present mainly on the back of the penis and not on the front the urinary opening is lower down and not at the tip the gland penis that is the head of the penis also has a deep groove or a cut so what should have been here at the tip is lowered down and it is not always fixed at this position it can be anywhere from just below the tip to all the way down till the scrotum This Is A congenital problem where the development of the anterior or the front of the penis is uh deficient so there are lot of tissues like the skin and the deeper tissues which have not completely developed the Ural tube instead of traveling all the way till the end falls short and opens on the under surface it's a range of abnormality where it can be just below its normal position or all the way down very close to the scrotum along with the abnormality of the opening there is also a curvature which occurs in the penis and this is called as cardi this condition has to be corrected because a boy as he grows will have issues where he will not be able to stand and pass urine the urinary stream will be more directed towards his own legs and when he's a complete adult male he will have issues with sexual intercourse so this condition is treated by surgery which is better performed between the age of 1 year to 18 months this age is selected because one it's easier to handle the tissues the growth of the pennis is sufficient to hold the sutures well the children will not have the memory of the surgery being performed and doesn't have any psychological impact also at this age it is not a hair bearing organ so the chances of infection are less because of these four important points the surgery is better performed between 1 year to 18 months if you can imagine this to be the urethal tube the anterior portion is deficient and therefore there's only half of the tube which is present tubularized or making it this part into a tube will only narrow the caliber so during surgery we need to use the tissues in the surrounding to make a complete tube the four skin is also deficient it is more on the back of the penis and not on the front so this surgery is basically a craftmanship it involves art where we need to mobilize the tissues and move them to different area so that we can regenerate or recreate a normal looking uretra once the surgery is performed most of the time it would look like as if it's just a circumcision has been performed all the surgical steps are directed to correct the anatomy or the structure of the penis but it will not affect in any way the function so there will be no issues in the boy passing urine or his sexual intercourse what are the complications that can occur because this involves very fine suture materials as thick as a hair strand and there are multiple layers of stitches involved there can be something called as a fistula a fisha means it's a small pinpoint hole where the urine can leak so imagine a host pipe or a garden pipe where there's a small little hole from which the water is leaking so falize something similar to that any form of surgery can have a significant amount of fular rates therefore at manipal hospital sjur road we have uh corrected and with lot of years of testing we have devised methods where we can bring this to a very minimal rate of just 1% fisha is not completely avoidable but we have reduced it to a significant low number that majority of of our cases do not have fisha apart from these there are usually no major complications then there are few cases where I said the opening can be low down all the way up to the scrotum so in these cases surgery needs to be performed under two stages the first stage where we mobilize the tissue we make a base ready for the second stage and the second stage is where the actual tube is formed so the surgery can be performed in single stage for minor degree of hypospadias and two stages in major degrees of major hypospadias overall it is nothing to be too much of a worry it's a condition which can be completely corrected and a boy can have a normal uh functioning and sexual intercourse uh when he grows up so hypospadias is completely correct correctable meet a pediatric urologist for this condition to know more thank you

Dr.

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