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Hypocrisy, or in other words "hypospadia", is a congenital defect of the urinary system, which consists in locating the opening of the urethra on the abdominal side of the penis, which means colloquially speaking - "underneath". Hypocrisy, depending on the severity of the defect, may have a greater or lesser impact on the daily life and functioning of patients.

Hypospadias( hypospadia ) was already described by scholars in the first centuries of our era. At that time, of course, it was not yet known what consequences this defect could have, but due to the problems of men, the most drastic treatment method possible, i.e. amputation of the distal penis, was used for nearly a thousand years. With time, as medicine progressed and learning about human anatomy and physiology, treatment improved significantly. Interestingly, despite the fact that hypospadias is a disease attributed to the male sex, some authors also distinguish female hypospadias when the outer opening of the urethra is more posterior than is the case under physiological conditions. Sometimes it can even be located on the anterior vaginal wall.

Spodziectwo - epidemiology

Hypocrisy is one of the most common congenital abnormalities of the genitourinary system in boys. Its frequency can be estimated at approximately 1: 250 - 1: 300 live male newborns. The incidence is higher in children who have a positive family history of hypospadias, but it has not been established how this condition may be inherited. In addition to genetic factors, it is also estimated that endocrine and environmental factors play an important role in the etiology of hypospadias. Studies have shown a relationship between the occurrence of hypocrisy and estrogens or phytoestrogens, antiandrogens, and DDT (dichlorodiphenyltrichlorethane). An increased incidence of hypophagia was also observed in children whose mothers took diethylstilbestrol during pregnancy or who had flu in the first trimester. Other risk factors for hypophagia include very young or old age of the mother during pregnancy and low birth weight.

Spodziectwo - pathophysiology

Hypospadias develops around the twelfth week of fetal life as a result of improper closure of one of the structures - the urethral plate, as well as disturbed recanalization of the so-called endodermal cord within the glans penis. For the development of male sexual organs in utero, they play a major roleandrogens (testosterone). Therefore, if a factor interferes with the proper functioning of the androgen-androgen receptor axis, the urethra may abnormally develop, leading to hypospadias.

How can we divide hypocrisy?

Over the years, hypocrisy has been classified in various ways, more or less detailed. However, the most common division is location-based hypospadias, which includes acorn, penile, and scrotal (or perineal) hypospadias. Sometimes an intermediate, penile-scrotal (or penile-perineal) form is also distinguished.

  • Acorn Hypocrisy- This is the most common form of hyperemia, accounting for approximately 65% ​​of cases. The external opening of the urethra is located within the glans penis, between the gut groove and the apex. In this form of hypophagia, the development of the penis is usually not disturbed, we only observe a slight bending of the glans with the presence of a urethral groove on its abdominal side. Often there is an enlargement of the foreskin, and the narrowing of the external opening of the urethra requires intervention already in the neonatal period. It is not the worst prognostic form, however, an early, specialized surgery in specialized centers is needed to prevent secondary complications from developing.
  • Penile hypocrisy- accounts for approximately 20% of all hyperemia. The external urethral opening is located on the ventral side of the penis, between the gastric groove and the scrotum, and more specifically the penile-scrotum angle. The most common comorbidities are penile flexion, as well as other accompanying developmental defects.
  • Perineal hypocrisy- the rarest and most serious form of hyperemia. The opening of the urethra is in this case between the folds of the split scrotum. Sometimes it happens that the penis is not fully developed, which, together with other abnormalities, may raise doubts as to the sex of the child, so in the most severe cases, sometimes a more detailed genetic or hormonal diagnosis is necessary.

Sometimes a figure called "hypocrisy without hypocrisy" is also observed. It consists in the fact that the opening of the urethra is located correctly, but due to the bending of the penis, it gives the impression of hypophagia. Sometimes there is also a cleft foreskin.

Spodziectwo and other birth defects

Other malformations of the genitourinary system and organs in its vicinity are often observed in patients with the most severe forms of hypospadias. Cryptorchidism is one of the most commonand an oblique inguinal hernia. They occur in 10 to 30% of patients with perineal hyperemia. In this form, the so-called "male vagina", i.e. a defect consisting in the presence of a persistent prostatic diverticulum, often coexists.

Hypoderma - treatment

Treatment of hypospadias is only operational. It used to be believed that postponing the procedure until the age of 3-4 years would be the optimal solution, because then the penis is already so developed that the procedure is easier than in a newborn. Depending on the severity of the defect, hypospadias may be asymptomatic but may also contribute to urine stagnation above the obstruction of the urethral opening. For this reason, it is currently recommended not to delay surgery for too long and to start treatment in the first, at the latest, in the second year of life. Some authors believe that a minor defect that does not obstruct the outflow of urine and is merely a cosmetic defect does not require surgery. However, this view is still controversial in many people, as hypocrisy later in life can have a negative impact on sexual and psychological aspects.

Surgical techniques may differ depending on the centers, but they are always based on several successive stages, namely penile straightening (if necessary), urethral reconstruction, glans plastic surgery, reconstruction of the abdominal layers of the penis and ultimately on the reconstruction of the foreskin.

Spodziectwo - prognosis

In the vast majority of cases, surgical treatment of hypospadias gives at least satisfactory results. Sometimes only the reconstruction of the foreskin is a problem. Hypospadias surgery is associated with the risk of certain complications, the most common of which is the urethral fistula. Its frequency varies depending on the method of surgery used and, unfortunately, most often it does not close spontaneously, which is why it is usually necessary to reoperate by surgical closure. Other complications of hypophagia surgery include stenosis in the operated area, which sometimes coexists with a fistula. It can result in recurrent inflammations of the urinary tract, and treatment consists of dilating the urethra with Hegar's dilators or, in some cases, reoperation.

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Male diseases