penis-like urethra
Introduction
Introduction Penile-like hypospadias is the most common congenital malformation in the male genitourinary system, with an incidence of 1 in 300. The urethral ectopic opening in the ventral side of the urethra is called hypospadias. The hypospadias opening can occur anywhere from the perineum to the penis head. The distal end of the external urethra, the urethra and surrounding tissues are underdeveloped, and the formation of a fiber cord involves the penis, causing the penis to bend to the ventral side. Congenital penile curvature is not all of the hypospadias, but the hypospadias have different degrees of penile curvature.
Cause
Cause
The cause of the penile urethra:
(1) Causes of the disease: In recent years, the etiology of hypospadias has been summarized in several aspects.
1. Endocrine factors: partial cases of androgen receptor and 5-reductase deficiency. It has also been found that after stimulation with human chorionic gonadotropin (HCG), the androgen increase response in patients with hypospadias is significantly lower than that in the normal control group, suggesting that the hypothalamic-pituitary-gonadal axis of patients with hypospadias is not normal.
2. Environmental factors: Some studies have found that the incidence of hypospadias in neonates who have used progesterone in the early pregnancy is higher, and studies have shown that the levels of estradiol and estrone in patients with hypospadias increase. These studies suggest that estrogens antagonize androgen action.
3. Chromosomal abnormalities: The chromosomal aberration rate in patients with hypospadias is significantly higher than that in the normal population, including autosomal aberrations and sex chromosome aberrations.
4. Gene mutation: Patients with hypospadias may be found to have an androgen receptor gene, sex determining gene, 5-reductase gene, anti-Mullerian hormone gene, and mutation of CYP21B gene.
(2) Pathogenesis:
During embryonic development, the development and fusion of the ventral genital tract in the penis is affected by pituitary and androgen. If the androgen is deficient, the fusion of the wrinkles on both sides of the genital tract will cause a defect in the ventral side wall of the urethra, and the urethra will open behind the normal urethral opening of the ventral side of the penis to form a hypospadias. According to the location of the urethral opening, the hypospadias can be divided into four types: penis head type, penis type, penis scrotum type and perineal type. Among them, the penis head type and the penis type account for the majority.
Examine
an examination
Related inspection
Penile ultrasound examination of chromosome cystoscope
Examination of the penile urethra:
Symptoms: Symptoms of penile hypospadias The urethra is located on the ventral side of any part of the junction of the coronary sulcus to the penis scrotum. The urethral plate at the distal end of the urethral opening is separated, no tubular shape is formed, the penis is bent to the ventral side, and the urethra is more The more severe the curvature near the side, affecting sexual intercourse and urination, but also affect fertility. The shape of the penis head and foreskin is the same as that of the penis head type.
2. Diagnosis: The diagnosis is relatively easy, and the diagnosis can be made based on the appearance characteristics. Laboratory, X-ray, endoscopy: penis scrotum type and perineal type of urethra often accompanied by scrotal division, the external reproductive organs sex is difficult to determine, so oral buccal mucosa smear and karyotype should be examined to determine gender. Urethoscopy and cystoscopy can be used to understand the development of a colon in males; excretory urography can be used to understand whether congenital malformations of recurrent kidneys and ureters are combined. Excretory urethrography for patients with hypospadias can be classified as a routine examination. However, the value of glans type hypospadias is small, because the incidence of upper urinary tract malformations in these patients is not higher than that of ordinary people.
complication:
1. Cryptorchidism and inguinal hernia: The most common concurrent malformation of hypospadias is cryptorchidism and inguinal hernia, the incidence of which is 7% to 13%, and the closer the urethral opening is to the scrotum, the higher the incidence.
2. Urinary tract malformation: the incidence of posterior hypospadias is about 1% to 5%. The incidence of other system malformations is high, and the incidence of malformation in other systems is 7%, and the incidence of malformation in both systems is 13%. The incidence of three system malformations was 37%.
3. Prostate sac: Prosthetic sac is a manifestation of Müllerian insufficiency or urinary sinus dysplasia during embryonic development. The incidence in patients with posterior hypospadias is 10% to 15%. Cause urinary tract obstruction, intracranial stone formation and infection.
4. Sexual malformation: severe hypospadias such as the gender characteristics of the external genitalia such as testicular insufficiency, small penis, penile scrotum transposition, scrotal division and other manifestations, should pay attention to the situation of hermaphroditism, should be chromosome examination and Check about endocrine function. Uncommon accompanying malformations include anal atresia and meningocele.
Diagnosis
Differential diagnosis
Identification of confusing symptoms of the penile-like urethra:
Identification of other types of hypospadias:
1. Penis head type: The urethral opening is located in the ventral side of the coronary sulcus, often in the form of a fissure. Some may have urethral stricture, the dorsal foreskin is long, and the ventral side has no foreskin and ligament. The penis head is bare, small and slightly flat and spherical. The penis bends to the ventral side, but to a lesser extent, it does not affect sexual intercourse and urination.
2. Penis scrotum type: The urethral opening is located in the midline of the scrotum, and the scrotum is often split like a female labia majora. A fiber cord is formed at the distal end of the urethral opening. The penis is severely bent and needs to be urinated. The penis is short and flat, and some resemble female clitoris. Some testicles do not fall into the split scrotum or form penile scrotum transposition.
3. Perineal type: the urethral opening is located in the perineum, the scrotum is divided, the development is incomplete, and the cryptorchidism can be combined. The penis is small and curved, which is like a hypertrophic clitoris. The entire genital development is like a female vulva, which is mistaken for women by many parents. Need to urinate.
Symptoms: Symptoms of penile hypospadias The urethra is located on the ventral side of any part of the junction of the coronary sulcus to the penis scrotum. The urethral plate at the distal end of the urethral opening is separated, no tubular shape is formed, the penis is bent to the ventral side, and the urethra is more The more severe the curvature near the side, affecting sexual intercourse and urination, but also affect fertility. The shape of the penis head and foreskin is the same as that of the penis head type.
2. Diagnosis: The diagnosis is relatively easy, and the diagnosis can be made based on the appearance characteristics.
Laboratory, X-ray, endoscopy: penis scrotum type and perineal type of urethra often accompanied by scrotal division, the external reproductive organs sex is difficult to determine, so oral buccal mucosa smear and karyotype should be examined to determine gender. Urethoscopy and cystoscopy can be used to understand the development of a colon in males; excretory urography can be used to understand whether congenital malformations of recurrent kidneys and ureters are combined. Excretory urethrography for patients with hypospadias can be classified as a routine examination. However, the value of glans type hypospadias is small, because the incidence of upper urinary tract malformations in these patients is not higher than that of ordinary people.
complication:
1. Cryptorchidism and inguinal hernia: The most common concurrent malformation of hypospadias is cryptorchidism and inguinal hernia, the incidence of which is 7% to 13%, and the closer the urethral opening is to the scrotum, the higher the incidence.
2. Urinary tract malformation: the incidence of posterior hypospadias is about 1% to 5%. The incidence of other system malformations is high, and the incidence of malformation in other systems is 7%, and the incidence of malformation in both systems is 13%. The incidence of three system malformations was 37%.
3. Prostate sac: Prosthetic sac is a manifestation of Müllerian insufficiency or urinary sinus dysplasia during embryonic development. The incidence in patients with posterior hypospadias is 10% to 15%. Cause urinary tract obstruction, intracranial stone formation and infection.
4. Sexual malformation: severe hypospadias such as the gender characteristics of the external genitalia such as testicular insufficiency, small penis, penile scrotum transposition, scrotal division and other manifestations, should pay attention to the situation of hermaphroditism, should be chromosome examination and Check about endocrine function. Uncommon accompanying malformations include anal atresia and meningocele.
