Best Hypospadias Surgeon in Kolkata | मूत्र का छिद्र सही जगह पर न खुलने की समस्या | Dr Nagwani

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In this video, DR ANAND KUMAR NAGWANI discussed Hypospadias treatment in this video DR Nagwani discussed, How to treat hypospadias and feedback of successfully treated patients.

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Treating Hypospadias is a Painless Process

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Etiology & Pathophysiology
The condition is thought to be caused by under-stimulation of the genital tubercle and penis by dihydrotestosterone, resulting in failed fusion of the urogenital folds. However, deficiency or abnormality of testosterone, dihydrotestosterone, or 5-α reductase is not commonly found in hypospadias alone. Direct etiology is unknown in most cases and it appears to be a multifactorial process with links made to hormonal changes, genetic susceptibility, and environmental factors. Female sex hormones have been implicated and the ever-increasing use of estrogens has been suggested as a possible cause for the recent rise in incidence. In addition, it is five times more common in boys born from IVF – possibly due to the effects of material progesterone on 5-alpha reductase.

Monozygotic twins have 8 times increased risk of hypospadias compared to single-tons. This may be due to in-utero competition for HCG. In some cases, there also appears to be a genetic link. Of affected boys, 8% have affected fathers and 14% have affected brothers. If two family members are affected, the risk for a subsequent boy is 22%

Presentation
The prominent presenting feature of hypospadias is the abnormal urethral opening. The external urethral meatus or opening is present under the surface of the penis anywhere from the glans, the shaft of the penis, to the scrotum or perineum. Parents are usually complaining of soiling of clothes during urination. The foreskin looks abnormal (hooded prepuce). The penis is curved (chordee). The urinary stream is narrow (due to pinhole meatus or opening). Sometimes present due to other anomalies like inguinal hernias and undescended testes.
Indication
Indication of treatment is functional, social, and cosmetic.
Functional urinary stream is not straight/spray of urine/soiling of cloths
sexual gratification and or infertility(due to functional region) in adult life
Social
The male child has difficulty in urination in a standing position, if he does then his clothes become soil.
Cosmetic
Hypospadias is a congenital abnormality of the male external genitalia wherein the external urethral meatus is found to be abnormal position, maybe on the shaft of the penis, the scrotum, or the perineum.
This is accompanied by abnormal curvature of the penis in around 15% of cases, inguinal hernias in 9% of cases, and undescended testes in 9% of cases
Relevant Anatomy of penis
The two corpora cavernosa and the corpus spongiosum of the urethra with the glans form the penis.
These structures are made from erectile tissue surrounded by the tunica albuginea (Buck fascia) and by the dartos fascia more superficially, which contains terminal branches of external pudendal arteries and veins, pudendal nerves, and the superficial lymphatics.

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