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Management der Hypospadie

Management of hypospadias

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Zusammenfassung

Die Hypospadie sollte bei der Geburt diagnostiziert werden und eine detaillierte Aufklärung der Eltern erfolgen. Isolierte Hypospadien müssen unterschieden werden von sexuellen Differenzierungsstörungen, die zusätzlich meist mit einem Kryptorchismus und/oder einem Mikropenis einhergehen. Optimaler Operationszeitpunkt ist die Zeit um den 1. Geburtstag. Eine präoperative Hormontherapie wird nur bei sehr kleiner Glans und in der komplexen Rezidivchirurgie empfohlen. Die populärste Operationsmethode bei distalen Formen ist derzeit die Tubularisation der Harnröhre mit oder ohne mediane Inzision und bei proximalen Hypospadien mit ausgeprägter Krümmung ein zweizeitiges Vorgehen. Ein Dripping-Stent, ausgeleitet in eine Doppelwindel, ist beim Säugling die beste Methode der Harnableitung. Die Komplikationsrate nach Korrektur distaler Hypospadien liegt laut Literatur unter 10% und nach Operation proximaler Formen über 25%.

Abstract

Hypospadias are diagnosed at birth. Counseling of the parents should be performed in detail. Isolated hypospadias has to be differentiated from disorders of sexual development which are mostly associated with cryptorchidism and micropenis. The operation is timed around the first birthday. Preoperative hormonal treatment should be reserved for infants with a small glans penis or for repeat surgery. The most popular method in distal hypospadias repair is preservation of the urethral plate and tubularization with or without midline incision. In proximal cases with severe curvature a two-stage procedure may be preferable. Dripping-stent urinary drainage into a double diaper is the best method in infants. The complication rate after primary distal repair is reported in the literature to be less than 10% and after staged procedures in proximal hypospadias over 25%.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Riccabona gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Urologische Klinik und Poliklinik, Klinikum Großhadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland

    M. Riccabona

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Correspondence to M. Riccabona.

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Riccabona, M. Management der Hypospadie. Urologe 53, 741–750 (2014). https://doi.org/10.1007/s00120-014-3438-z

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  • DOI: https://doi.org/10.1007/s00120-014-3438-z

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