Hypospadias (synonym lower cleft of the urethra) - congenital malformation, i.e. the lack of the lower wall of the urethra. Is found only in males. The outer opening of the urethra when hypospadias is located on the underside of the penis, the scrotum, or even on the perineum. Depending on this, there are three degrees of hypospadias: I degree - hypospadias head; II degree - hypospadias penis; III degree - scrotal or scrotal-perineal hypospadias. Hypospadias is accompanied by the curvature of the penis, sometimes (when hypospadias II and III degrees) so significant that impaired urination (sprayed jet of urine gets on the skin of the scrotum, hips and linen; patients with scrotal and scrotal-perineal-hypospadias can only urinate sitting), difficult intercourse. Often when hypospadias narrowed external opening of the urethra. If hypospadias III degree, there are often difficulties in determining the sex of the child, as the underdeveloped penis reminds engorged clitoris, and split scrotum - bawdy lips. In such cases, the necessary consultation of doctors-urologists, endocrinologists.
Treatment. Hypospadias I degree requires no treatment. If hypospadias II and III only surgical treatment is a multi-stage surgery to straighten the penis and recovery of the urethra. To send on surgical treatment of patients with hypospadias should at the age of 3-5 years, until he developed persistent deformation of the penis.

Hypospadias. This malformation of the urinary canal missing his back wall of a particular course and the outer hole is located on the rear surface of the penis or on the perineum.
Violation of embryonic development of the urethra at various stages leads to a greater or lesser period of its peripheral part remains neschastnym and underdeveloped, and the outer hole is at different distance back from its normal location.
Accordingly, there are four degrees of hypospadias: 1) the hypospadias head (hypospadia glandis), 2) the hypospadias in the penis, or penile (hypospadia penalis), 3) scrotal hypospadias (hypospadia scrotalis) and 4) perineal the hypospadias (hypospadia perinealis).
If hypospadias heads the urethra opens immediately behind her on the back surface of the penis dot or wide slotted, which in the distal direction stretches of non-consolidation segment of the urethra. The latter is frequently shortened and pulls head down.
When penile hypospadias the opening of the urethra is for penis between coronal sulcus and scrotum, when the scrotal - on the middle line of the scrotum, with perineal hypospadias - crotch behind the scrotum (Fig. 66).
The last two forms of hypospadias scrotum as if divided into two halves. If there cryptorchidism that hypospadias is observed frequently, such divided into two scrotum is very similar large private parts lips. At the same time, the short head of the penis when perineal hypospadias, bent down and pulled to the scrotum, is reminiscent of the clitoris; in General, it is the impression of the external female genitalia. Due to the lack of testes in the scrotum sometimes require additional tests (determination of hormonal profile, rectal examination for the presence of the internal female genitals)to determine the sex of the patient.
Treatment consists of two elements: 1) the straightening of the penis) and 2) the creation of a missing segment of the urethra. The first is achieved by excision shortened non-consolidation of the urethra, cicatricial fibers and skin folds, attracting penis down; the second is the education of missing part of the urethra by one of the numerous plastic surgeries, proposed for this purpose.

Fig. 66. Various degrees of hypospadias.