Urethral congenital anomalies are defects occurring during fetal life.
Hypospadias is the condition where the opening of the urethra is located on the lower surface of the penis and not on the glans apex.
Based on the output site of the urethra into the penis, hypospadias is categorized into:
- Anterior hypospadias
- Middle hypospadias
- Posterior hypospadias
The specific causes of hypospadias are not known.
Genetic and environmental factors involved in the development of hypospadias are:
- Family history: it occurs more frequently in infants who have relatives suffering from hypospadias.
- Mother over the age of 40
- Smoking and exposure to chemical pesticides: research has shown an association between hypospadias and exposure to pesticides and smoking of the mother
The vast majority of the cases are diagnosed upon childbirth.
Following the diagnosis, other factors must also be taken into consideration, such as:
- Urethral orifice location
- Penile curvature (bending)
- Penile size
- Location of the testicles (in 10% of the cases cryptorchidism co-exists)
- Possible congenital anomalies of the kidneys and bladder
Treatment is surgical and aims at restoring the penis both functionally and aesthetically.
There are various surgical techniques, all of which must be carried out when the infant is aged between 6 and 18 months.
In some cases, restoration is achieved with a single surgery while other cases may require more than one.
It constitutes a rare anomaly of the urethra and is more common in boys (1 in 120,000 births).
In this condition, the urethral orifice is located on the dorsal (topside) surface of the penis.
In most of the cases, diagnosis is delivered antenatally (after birth).
Treatment depends on the gender of the infant and the type of epispadias.
Usually, a series of surgical procedures are required and they aim at the functional and aesthetic repair of the penis as well as urinary retention restoration.
Posterior urethral valves
It is one of the most serious conditions in the field of Pediatric Urology and the most common congenital urethral anomaly.
Its incidence ranges from 1 in 8,000 to 1 in 25,000 in young males only.
Posterior urethral valves cause obstruction, resulting in secondary disorders in the bladder, kidney and in sexual function.
Nowadays, diagnosis is performed as part of prenatal screening, i.e. ultrasound during pregnancy.
Given that it may cause serious and permanent damage to the renal function, immediate and effective surgical removal of the posterior urethral valves is essential.