Urologie pro praxi 5/2003
Hypospadie
Hypospadias Hypospadias and the urethra cleft on lower parties attack one of 125 to 300 born boys. It is one of the most often congenital anomalies of the urinary tract. The cause of hypospadias is tilll this time unknown but genetic and hormonal relationshipes can have an impact on this problems. Classificacion of hypospadias has been based by the meatal pozition – distal shaft 50% (glandular, coronal, subcoronal), mid shaft – 20% (penile) and proximal shaft – 30% (penoscrotal, scrotal, perineal). The hypospadias with chordee occurs as an isolated unit. The distal shaft hypospadias may cause a psychlogical trauma to the involved boys, the other forms of hypospadias could cause a disorders of voiding and ejaculation. Impossibility of sexual intercourse is presented at forms with chordee. Defect has to be diagnosed immediately after birth by a peadiatrist and it´d be considered by a pediatric urologist into 3–6 month. The treatment is only surgical. Recently there is an effort to operate hypospadic boys in one time since 6 month to 2 years of age. A double urethral suture with deep dorsal incision of plate according to Snodgrasse is advised for the distal shaft hypospadias. A tubulizated flap or free graft, especially from buccal mucous membrane, are applied in cases of a mid shaft or proximal shaft urethra. The island flap is stitched to the urethral plate by „onlay“ method according to Ducketa. The „inlay-onlay“ urethroplasty according to Kočvara is used when there is a low quality or missing urethral plate. The tubulizated flap according to Ducket is rarely used. Good cosmetic effect and function are expected after urethroplasty. Key words: hypospadias, chordee, urethroplasty, flap, graft.
