Abstract
Hypospadias is defined as ventral dystopia of the external urethra of the urethra on the penis, scrotum, or perineum due to impaired medial fusion of the urethral ramparts at an early stage of embryonic development. It also includes a split, apron-shaped deformation of the foreskin, which thus covers the dorsal part of the also split, flat gland.
The presence of the so-called chorda, ventral bending of the penis caused by the fibrous transformation of the corpus spongiosum urethrae, is also common. Hypospadias is the most common lower urinary tract malformation with an incidence of 3.3 per 1000 boys born, making it one of the most common congenital malformations.
According to the location of the external meat and the degree of malformation of the genitalia, hypospadias are divided into distal type (glandular, coronary and subcoronary) with an incidence of 65%, middle type (hypospadia penis media) with an incidence of 15% and proximal (penile, penascrotal and perineal) %. Hypospadias are a manifestation of feminization in boys, which is more severe the outcome of the external meat more proximally, and the more associated malformations are expressed, such as the presence of chords, scrotal hypoplasia, and testes and their descent disorder with the possible presence of rudimentary parts of the female genitalia.
The presence of the chord is reported in about 35%, the possible existence of rudiments of the female genitalia and other manifestations of insufficient sexual differentiation should be borne in mind when examining any child with proximal forms of this defect. In boys with hypospadias, associated urinary tract anomalies tend to be, but fortunately they are of little functional significance.
In hypospadias, disorders of micturition are variously expressed, from the spraying of the urine stream and its ventral direction in distal forms to the impossibility of micturition while standing in proximal forms. The need to mock sitting in a girl's way contributes to the psychological trauma of the child and the disorder of his sexual identification, if the defect is not resolved in early childhood.
Stenosis of malformed external meat can only result in infravesical obstruction with morphological and functional changes, such as bladder instability, detrusor muscle hypertrophy and diverticulum formation. In the case of an unresolved defect, a fertility disorder due to erectile dysfunction is associated in adulthood, possibly also impotentia generandi in spermiogenesis disorders.
The development of the urogenital tract is relatively complicated, its complexity in many respects comparable to the cardiovascular system, which puts both systems at the forefront of the number of birth defects. The development of the gonads begins with an indifferent stage, when it is not possible to distinguish whether they run on the basis of a female or male gonad.
Further differentiation depends on the presence of H-Y antigen and on the existence of specific receptors in the membrane of indifferent gonadal cells capable of binding H-Y antigen. In the positive case, the testicle is differentiated and its secretory activity determines the masculinization of the future child.
Proliferation of the cloaca entoderm creates a urethral disc that extends externally to the ectoderm. By the separation of the urethral disc, the urethral furrow deepens, in the 3rd month these urethral algae coalesce around the orificium urogenitale and their rapid coalescence gives rise to the urethra.
From the apex, an ectoderm plate grows to the urethra, which merges with the entoderm of the urethra and lumines. The cavernous bodies are formed by the mesenchyme forming the base of the phallus, which turns into a connective tissue and dehiscence creates lacunae in it, which connect with the blood vessels.