HYPOSPADIAS – Causes and Risk Factors, Clinical Manifestations, Diagnostic Evaluations, Treatment and Nursing Diagnosis
Hypospadias is a congenital defect with misplaced urinary opening. Hypospadias refers to a urethral meatus which is located along the underside, rather than at the tip of the penis.
Hypospadias is an abnormality in the development of the urethra, the tube that carries urine, in the penis. Normally the urethra extends the full length of the penis and its opening is at the glans or tip of the penis. With hypospadias, however, the opening can be anywhere along a line running down the underside of the penis called the urethral groove. In the majority of the cases, first degree hypospadias, the opening is on the glans and these cases are the least severe. In the more severe cases the opening is on the shaft (second degree) or perineum (third degree), and can often involve other complications.
CAUSES AND RISK FACTORS
Hypospadias is present at birth (congenital). In many cases, the cause is unknown. Sometimes hypospadias is inherited.
As the penis develops in a male fetus, certain hormones stimulate the formation of the urethra and foreskin. Hypospadias occurs when a defect occurs in the action of these hormones, causing the urethra to develop abnormally.
This condition is more common in infants with a family history of hypospadias. These also may be an increased risk of hypospadias in infant males born to women of an advanced age or those who used in vitro fertilization (IVF) to conceive. The connection to IVF may be due to the mother’s exposure to progesterone, a natural hormone, or to progestin, a synthetic form of progesterone, administered during the IVF process.
CLINICAL MANIFESTATIONS
- Opening of the urethra at a location other than the tip of the penis
- Downward curve of the penis (chordee)
- Hooded appearance of the penis because only the top half of the penis is covered by foreskin
- Abnormal spraying during urination
- Psychological problems about being ‘different’ to normal are common
- Passing urine is different to normal
- Sitting on a toilet may be needed to pass urine without mess
DIAGNOSTIC EVALUATIONS
A history taking and physical examination can diagnose this condition. Imaging tests may be needed to look for other congenital defects.
TREATMENT
Treatment involves surgery to reposition the urethral opening and, if necessary, straighten the shaft of the penis.
Infants with hypospadias should not be circumcised. The foreskin should be preserved by use in later surgical repair. Surgery is usually done before the child starts school. Today, most urologists recommend repair before the child is 18 months old. During the surgery, the penis is straightened and the hypospadias is corrected using tissue grafts from the foreskin. The repair may require multiple surgeries.
During surgery, a pediatric urology surgeon uses tissue grafts from the foreskin or from the inside of the mouth to reconstruct the urinary channel in the proper position, correcting the hypospadias. The surgery usually takes from 90 minutes to three hours and is done while the child is unconscious (general anesthesia).
NURSING DIAGNOSIS
- Urinary incontinence related to urethra opens on the underside of the penis or on perineum.
- Ineffective sexual pattern r/t urethra opens on the under surface of penis and curved penis.
- Risk for urinary tract infection related to urethral open
- Anxiety related to surgery
- Knowledge deficit related to disease condition
HYPOSPADIAS – Causes and Risk Factors, Clinical Manifestations, Diagnostic Evaluations, Treatment and Nursing Diagnosis