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Hypospadias kya hai
Zyadatar larkon mein peshab nikalne ka raasta (meatus) penis ki bilkul nok par hota hai. Hypospadias mein raasta neeche ki taraf hota hai, nok aur penis ki jad ke darmiyan, ya kabhi aur peeche. Yeh paida hone se hota hai aur paida hone ke muaine mein ya jald hi pakra jata hai.
Yeh naye paida hone wale larkon mein aam farq hai, aur qabil-e-ilaaj hai. Bohat se larkon ko tajarbe-kaar bachon ke surgeon se sirf aik operation ki zaroorat hoti hai, aur woh khare ho kar peshab karte hain, seedha aur aam nazar aane wala penis rakhte hain, aur aam zindagi guzarte hain. Yeh guide walidain ke liye hai. Yeh batati hai ke yeh kya hai, abhi khal ko kyun nahi chhedna chahiye, aur kya umeed rakhni chahiye.
Yeh kisi ki ghalti nahi. Yeh na hamal mein maa ke khane, lene ya karne se hota hai, na walidain ke kisi kaam ya kisi kaam na karne se.
Yeh kitna aam hai
Hypospadias naye paida hone wale larkon mein genitals ko mutasir karne wale aam farq mein se aik hai. Yeh halki shakal se, jis mein raasta nok se zara neeche hota hai, zyada shadeed shakal tak hota hai, jis mein raasta zyada peeche aur penis mein wazeh jhukao hota hai.
Yeh kyun hota hai
Urethra, yaani peshab ki nali, aur khal hamal ke shuru ke hafton mein banti hain. Hypospadias mein yeh aam tareeqe se mukammal nahi hoti. Zyadatar larkon mein koi wajah nahi milti. Yeh khandan mein chal sakta hai, aur kabhi doosre asbaab bhi shamil hote hain, lekin kuch aisa nahi jo walidain rok sakte hon ya jis ke woh zimmedar hon.
Yeh kaise nazar aata hai
Aap ya doctor yeh dekh sakte hain:
- Peshab ka raasta nok par nahi, neeche ki taraf hai.
- Topi jaisi khal. Khal samne se topi ki tarah lagti hai, aur neeche se adhoori ya ghayab hoti hai.
- Peshab ki dhaar neeche ki taraf jati hai ya bikharti hai, is liye bare larkon ko peshab ke liye baithna par sakta hai.
- Penis ka neeche ki taraf jhukao (chordee), jo erection mein zyada nazar aata hai.
- Kabhi testicle neeche nahi utre hote (dekhein undescended testis guide).
Hypospadias wale zyadatar larke baqi har tarah se theek hote hain. Meherbani karke yeh na samjhein ke yeh kisi aur masle ki nishani hai, lekin doctor se check karwayein.
Pehle khatna na karein
Walidain ke liye yeh sab se aham baat hai. Hypospadias wale larke ka khatna us waqt tak nahi karna chahiye jab tak bachon ka surgeon usay dekh na le. Marammat ke operation mein aksar khal ki zaroorat hoti hai. Agar woh pehle hi nikal di gayi ho to marammat mushkil ho jati hai aur nateeja utna achha na ho sakta hai.
Pakistan mein khatna aksar paida hone ke baad jaldi, ghar par ya chhote clinic mein hota hai, kabhi kisi ke dhyan se dekhne se pehle. Agar aap ke bachay ki khal topi jaisi ho ya peshab ka raasta theek nazar na aaye to meherbani karke khatna karne wale se kahein ke ruk jaye aur pehle doctor se muaina karwayein.
Kaise check hota hai
Doctor penis ka muaina karta hai, aur aksar bas yahi kaafi hota hai. Doctor raaste ki jagah, khal, penis ke jhukao, aur testicle dekhega. Aam tor par scan ya khoon ke tests ki zaroorat nahi hoti. Agar raasta zyada peeche ho, ya testicle neeche na utre hon to doctor doosre farq ke imkaan mein mazeed jaanch ka intezam kar sakta hai.
Agar aap ko upar di gayi nishaniyon mein se koi bhi nazar aaye, chahe aap ka bacha theek lagta ho, to meherbani karke doctor ko dikhayein. Bachon ka surgeon jitni jaldi dekhe, aap utni behtar planning kar sakte hain.
Ilaaj ke tareeqay
Ilaaj is par mabni hai ke raasta kitna peeche hai aur penis kitna jhukta hai.
Meherbani karke aisa surgeon aur hospital chunein jo yeh operation aksar karte hon. Tajarba bohat maayne rakhta hai. Agar bachon ke markaz tak safar karna paray to woh is qabil hai. Doosri raaye lene mein hichkichayen nahi.
Operation mein kya hota hai
Surgeon jhukao ho to usay seedha karta hai, peshab ki nali ka gum shuda hissa is tarah banata hai ke woh nok tak pohanche, raasta nok par rakhta hai, aur jild ki dobara shakal banata hai. Operation mein kuch ghante lag sakte hain, jo is par mabni hai ke yeh kitna pechida hai. Naye hisse ko theek hone dene ke liye aam tor par kuch din ke liye aik patli nali (catheter ya stent) lagi rehti hai. Aap ke bachay ko dressing hogi, aur woh usi din ya chhote qayam ke baad ghar ja sakta hai.
Operation ke baad
Aap ka surgeon tafseeli hidayaat dega. Aam tor par:
- Dard ki dawai doctor ke mashware se dein, aur apne bachay ko aaram aur pursukoon rakhein.
- Dressing aur zakhm ko hidayaat ke mutabiq saaf aur khushk rakhein, aur nahane aur nappy ki hidayaat par amal karein.
- Jitni muddat batayi jaye, sawari wale khilone, cycle aur sakht khel se parhez karein.
- Har follow-up visit par jayein. Surgeon zakhm ke bharne aur peshab ki dhaar ka jaiza lega.
Kuch larkon mein baad mein masla ho jata hai, jaise naye raaste ka tang ho jana, naye tube se chhota rissao (fistula), ya jhukao ka wapas aana. Yeh maloom khatre hain, aur aik mazeed chhote operation se zyadatar theek ho jate hain. Meherbani karke surgeon ko jaldi batayein agar dhaar patli ya kamzor ho jaye, ya peshab ghair mamooli jagah se nikle.
Bare hone par
Kamyab marammat wale zyadatar larke khare ho kar peshab karte hain, seedhi aam erection rakhte hain, aur aam fertility rakhte hain. Zyada shadeed hypospadias wale larkon ko zyada follow-up ki zaroorat ho sakti hai, aur kuch ko mazeed operation. Yeh aham hai ke aap apne bete ko jaise jaise woh barhe, umar ke mutabiq aur pursukoon tareeqe se samjhayein, taake woh sharminda na ho, aur agar mashwara diya jaye to balaghat ke dauran surgeon ko dikhate rahein.
Fauran madad kab lein
Agar operation ke baad aap ke bachay ko in mein se koi bhi ho to usay foran apne qareebi hospital ke emergency department le jayein, ya surgical team se rabta karein:
- Woh peshab nahi kar sakta, ya catheter gir gaya hai ya band ho gaya hai, aur us ka pait phoola hua hai ya woh takleef mein hai.
- Bukhar, ya woh bohat beemar hai.
- Zyada khoon ka bahao jo dressing bhigo de.
- Zakhm jo surkh, soojha hua, behta hua ya khulta hua ho.
- Shadeed dard jo dard ki dawai se kam na ho.
Meherbani karke jaldi doctor ko bhi dikhayein agar aap ke bete ki khal topi jaisi ho ya peshab ka raasta aisa na lage jaisa hona chahiye. Is ke liye emergency ki zaroorat nahi, lekin khatna karne se pehle surgeon se dekhne ko kahein.
Aam sawalaat
Kya yeh mere kisi kaam se hua?
Nahi. Yeh na hamal mein maa ke kisi kaam se hota hai, na walidain ke kisi kaam se. Zyadatar bachon mein koi wajah nahi milti.
Pehle khatna kyun nahi ho sakta?
Marammat mein aksar khal istemal hoti hai. Agar woh pehle nikal di jaye to surgeon ke paas theek se dobara banane ke liye kaafi khal na ho. Meherbani karke intezar karein jab tak bachon ka surgeon muaina na kar le.
Kya woh aam tor par peshab kar sakega aur bachay paida kar sakega?
Kamyab marammat ke baad zyadatar larke kar sakte hain. Shadeed maamlaat mein zyada follow-up aur kabhi mazeed operation ho sakte hain. Koi bhi nateeje ka waada nahi kar sakta, lekin aap ka surgeon bata sakta hai ke aap ke bete ke liye kya umeed rakhni chahiye.
Kya cream, injection ya dawaiyon se is ka ilaaj ho sakta hai?
Hypospadias ka ilaaj operation hai. Kabhi chuninda larkon mein operation se pehle hormone ka mukhtasar course istemal hota hai, lekin sirf surgeon ke mashware se. Meherbani karke khud cream ya dawaiyan na khareedein.
Kya usay lazmi operation ki zaroorat hai?
Hamesha nahi. Bohat halki qismein aise hi chhodi ja sakti hain agar dhaar seedhi ho aur khandan ittefaq kare. Zyadatar hypospadias wale larkon ke liye operation ka mashwara diya jata hai. Aap ka surgeon intikhabat samjhayega.
Operation ke liye behtareen umar kya hai?
Aam tor par ise infancy ya shuru ke bachpan mein karne ka mashwara diya jata hai, taake bacha itna chhota ho ke use yaad na rahe. Aap ka surgeon bata sakta hai ke aap ke bete ke liye behtareen waqt kya hai.
Kya yeh khandan mein chalta hai?
Kabhi kabhi khandan mein chalta hai. Agar aap ka koi aur beta ya rishtedaar is mein mubtala ho to meherbani karke doctor ko batayein.
Kya us ka mazaq uray ga ya woh alag mehsoos karega?
Kamyab marammat aam tor par aam shakal deti hai. Ise saada baat samjhein, apne bete ko apne jism ke liye saade alfaaz sikhayein, aur agar woh bare hone par pareshan ya takleef mein ho to surgeon se baat karein.
What hypospadias is
In most boys the opening where urine comes out (the meatus) is at the very tip of the penis. In hypospadias, the opening is on the underside instead, somewhere between the tip and the base of the penis, or occasionally further back. It is present from birth and is found at the newborn check or soon after.
It is a common difference in baby boys, and it is treatable. Many boys need a single operation, done by an experienced children's surgeon, and go on to pass urine standing up, to have a straight and normal-looking penis, and to have a normal life. This guide is written for parents. It explains what it is, why the foreskin must be left alone for now, and what to expect.
It is nobody's fault. It is not caused by anything the mother ate, took or did in pregnancy, or by anything the parents did or did not do.
How common it is
Hypospadias is one of the more common differences affecting the genitals in baby boys. It varies from mild, with the opening just below the tip, to more severe, with the opening further back and a clear bend in the penis.
Why it happens
The urethra, the tube that carries urine, and the foreskin form in the early weeks of pregnancy. In hypospadias, this does not finish forming in the usual way. In most boys no cause is found. It can run in families, and sometimes other factors play a part, but nothing that parents can prevent or are to blame for.
How it shows
You or the doctor may notice:
- The urine opening is not at the tip, but on the underside.
- A hooded foreskin. The foreskin looks like a hood at the front, and is missing or incomplete underneath.
- The urine stream goes downwards or sprays, so older boys may need to sit to pass urine.
- A downward bend of the penis (chordee), most obvious during an erection.
- Sometimes the testicles have not come down (see the undescended testis guide).
Most boys with hypospadias are well in every other way. Please do not worry that it is a sign of something else, but ask the doctor to check.
Please do not circumcise first
This is the most important point for parents. A boy with hypospadias should not be circumcised until a children's surgeon has seen him. The foreskin is often needed in the repair operation. If it has already been removed, the repair becomes harder and the result may not be as good.
In Pakistan, circumcision is often done soon after birth, at home or in a small clinic, sometimes before anyone has looked carefully. If your baby has a hooded foreskin or the opening does not look right, please tell the person doing the circumcision to stop and ask a doctor to examine him first.
How it is checked
A doctor examines the penis, and often this is all that is needed. The doctor will look at the position of the opening, the foreskin, the bend of the penis, and the testicles. Usually no scans or blood tests are needed. If the opening is far back, or if the testicles have not come down, the doctor may arrange further checks in case of other differences.
Please see a doctor if you notice any of the signs above, even if your baby seems well. The sooner a children's surgeon sees him, the better you can plan.
Treatment options
Treatment depends on how far back the opening is and how much the penis bends.
Please choose a surgeon and hospital that do this operation often. Experience matters a lot. If travelling to a children's centre is needed, it is worth it. Do not hesitate to ask for a second opinion.
What the operation involves
The surgeon straightens the bend if there is one, builds the missing part of the urine tube so that it reaches the tip, places the opening at the tip, and reshapes the skin. The operation can take a few hours depending on how complex it is. A thin tube (catheter or stent) is usually left in for some days to let the new tube heal. Your child will have a dressing, and may go home the same day or after a short stay.
After the operation
Your surgeon will give you detailed instructions. In general:
- Give pain relief as advised, and keep your child comfortable and calm.
- Keep the dressing and wound clean and dry as instructed, and follow bath and nappy advice.
- Avoid riding toys, cycling and rough play for the time advised.
- Keep all follow-up visits. The surgeon will check healing and the urine stream.
Some boys develop a problem afterwards, such as a narrowing of the new opening, a small leak (a fistula) from the new tube, or a return of the bend. These are known risks, and a further small operation can fix most of them. Please tell your surgeon early if the stream becomes thin or weak, or urine comes out of an unusual place.
Growing up
Most boys with a successful repair pass urine standing up, have straight, normal erections, and have normal fertility. Boys with more severe hypospadias may need more follow-up, and some need extra operations. It is important to explain things to your son in an age-appropriate and calm way as he grows, so that he is not embarrassed, and to keep seeing the surgeon during puberty if advised.
When to seek urgent help
Take your child to the nearest hospital emergency department straight away, or contact the surgical team, if after the operation he has any of the following:
- He cannot pass urine, or the catheter has fallen out or is blocked, and his tummy looks swollen or he is in distress.
- Fever, or he is very unwell.
- Heavy bleeding that soaks the dressing.
- A wound that is red, swollen, leaking or opening.
- Severe pain that painkillers do not settle.
Please also see a doctor soon if your baby boy has a hooded foreskin or the urine opening does not look as expected. It does not need the emergency department, but please ask for the surgeon to see him before any circumcision.
Common questions
Did I cause this?
No. It is not caused by anything the mother did in pregnancy, or by anything the parents did. In most children no cause is found.
Why can't he be circumcised first?
The foreskin is often used in the repair. If it is removed first, the surgeon may not have enough skin to rebuild properly. Please wait until a children's surgeon has examined him.
Will he be able to pass urine normally and have children?
Most boys can after a successful repair. In severe cases, there may be more follow-up and sometimes extra operations. Nobody can promise an outcome, but your surgeon can tell you what to expect for your son.
Can it be treated with creams, injections or medicines?
Surgery is the treatment for hypospadias. Sometimes a short course of hormone treatment is used before the operation in selected boys, but only on the advice of the surgeon. Please do not buy creams or medicines yourself.
Does he definitely need an operation?
Not always. Very mild forms may be left alone if the stream is straight and the family agrees. For most boys with hypospadias, surgery is advised. Your surgeon will explain the options.
What is the best age for the operation?
It is usually advised in infancy or early childhood, so that the child is too young to remember. Your surgeon will tell you the best time for your son.
Is it passed on in families?
It sometimes runs in families. If you have another son or a relative with it, please tell the doctor.
Will he be teased or feel different?
A successful repair usually gives a normal appearance. Treat it as a matter of fact, teach your son simple words for his body, and talk to the surgeon if he becomes worried or distressed as he grows.