Y82 Hypospadias (ICD-10:Q54.9)

Introduction

Hypospadias is a congenital condition in males where the opening of the urethra is not at the tip of the penis, but on the underside. It is a relatively common condition, affecting approximately 1 in every 200-300 male births.^[1] The aim of this guide is to provide a comprehensive overview of the diagnosis and possible interventions for hypospadias.

Codes

• ICPC-2 Code: Y82 Hypospadias^[2]
• ICD-10 Code: Q54.9 Hypospadias, unspecified^[3]

Symptoms

• Abnormal urethral opening on the underside of the penis
• Curvature of the penis
• Foreskin abnormalities (e.g., hooded or ventral)
• Difficulty with urination^[4]

Causes

The exact cause of hypospadias is not well understood, but it is believed to be a combination of genetic and environmental factors. Potential causes include:

• Hormonal imbalances during fetal development
• Genetic mutations or variations
• Exposure to certain medications or chemicals during pregnancy^[5]

Diagnostic Steps

Medical History

• Gather information about the patient’s prenatal and birth history
• Inquire about any family history of hypospadias or other genital abnormalities
• Ask about any exposure to medications or chemicals during pregnancy^[6]

Physical Examination

• Evaluate the location of the urethral opening
• Assess the curvature or bend of the penis
• Examine the foreskin for any abnormalities^[7]

Laboratory Tests

• Urinalysis: to check for any urinary tract infections or abnormalities
• Hormone levels (e.g., testosterone): to assess for any hormonal imbalances^[8]

Diagnostic Imaging

• Ultrasound: to evaluate the structure of the urinary tract and identify any abnormalities
• Voiding cystourethrogram (VCUG): a type of X-ray that visualizes the flow of urine and identifies any issues with the urethra or bladder^[9]

Other Tests

• Genetic testing: to identify any genetic mutations or variations that may be associated with hypospadias
• Consultation with a pediatric urologist: for further evaluation and management recommendations^[10]

Follow-up and Patient Education

• Schedule regular follow-up appointments to monitor the progress of the condition
• Provide education on proper hygiene and care of the genital area
• Discuss potential treatment options and their associated risks and benefits^[1][4]

Possible Interventions

Traditional Interventions

Medications:

Top 5 drugs for Hypospadias:

1. Testosterone:
   • Cost: Varies depending on the formulation and dosage. Typically ranges from $20 to $100 per month.
   • Contraindications: Prostate or breast cancer, liver disease, heart disease.
   • Side effects: Acne, increased body hair, mood changes.
   • Severe side effects: Liver damage, cardiovascular complications.
   • Drug interactions: Warfarin, corticosteroids.
   • Warning: Regular monitoring of liver function and cardiovascular health is required.
2. Dihydrotestosterone (DHT) cream:
   • Cost: Varies depending on the brand and quantity. Typically ranges from $50 to $150 per month.
   • Contraindications: Prostate or breast cancer, liver disease, heart disease.
   • Side effects: Skin irritation, allergic reactions.
   • Severe side effects: None reported.
   • Drug interactions: None reported.
   • Warning: Use with caution in children, as safety and efficacy have not been well established.
3. Antibiotics (e.g., Cephalexin, Amoxicillin):
   • Cost: Generic versions can be $10 to $50 per course of treatment.
   • Contraindications: Allergy to penicillin or cephalosporins.
   • Side effects: Upset stomach, diarrhea.
   • Severe side effects: Severe allergic reactions, Clostridium difficile infection.
   • Drug interactions: None reported.
   • Warning: Finish the full course of antibiotics as prescribed.
4. Steroid cream (e.g., Betamethasone):
   • Cost: Generic versions can be $10 to $30 per tube.
   • Contraindications: Skin infections, open wounds.
   • Side effects: Skin thinning, increased risk of infection.
   • Severe side effects: None reported.
   • Drug interactions: None reported.
   • Warning: Use as directed and avoid prolonged use on large areas of the body.
5. Alpha-blockers (e.g., Tamsulosin):
   • Cost: Generic versions can be $10 to $40 per month.
   • Contraindications: Hypersensitivity to alpha-blockers.
   • Side effects: Dizziness, low blood pressure.
   • Severe side effects: Priapism (prolonged erection), severe allergic reactions.
   • Drug interactions: Other alpha-blockers, nitrates.
   • Warning: Use with caution in patients with cardiovascular disease.

Alternative Drugs:

• Hyaluronic acid gel injection: Used to correct mild hypospadias by filling in the defect. Cost: $500 to $1,500 per injection.
• Platelet-rich plasma (PRP) therapy: Involves injecting platelet-rich plasma to promote tissue regeneration. Cost: $600 to $1,200 per session.
• Hormone replacement therapy: May be considered for individuals with hormonal imbalances contributing to hypospadias. Cost: Varies depending on the specific hormones and dosages prescribed.

Surgical Procedures:

• Urethroplasty: Surgical reconstruction of the urethra to reposition the opening to the tip of the penis. Cost: $5,000 to $15,000.
• Foreskin reconstruction: Surgical correction of any abnormalities in the foreskin. Cost: $2,000 to $8,000.
• Glansplasty: Surgical reshaping of the glans (head) of the penis. Cost: $3,000 to $10,000.

Alternative Interventions

• Acupuncture: May help with pain management and overall well-being. Cost: $60 to $120 per session.
• Herbal supplements: Some herbs, such as turmeric and aloe vera, may have anti-inflammatory properties. Cost: Varies depending on the specific supplement.
• Nutritional therapy: A balanced diet rich in vitamins and minerals may support overall health and healing. Cost: Varies depending on individual dietary needs.
• Physical therapy: Pelvic floor exercises and stretching may help improve muscle tone and overall function. Cost: $60 to $100 per session.

Lifestyle Interventions

• Proper hygiene: Regular cleaning of the genital area to prevent infections. Cost: Varies depending on personal hygiene products used.
• Avoidance of irritants: Avoid exposure to chemicals or substances that may irritate the genital area. Cost: Varies depending on individual lifestyle choices.
• Healthy lifestyle: Regular exercise, a balanced diet, and adequate sleep may support overall health and healing. Cost: Varies depending on individual choices and preferences.

It is important to note that the cost ranges provided are approximate and may vary depending on the location and availability of the interventions. It is recommended to consult with a healthcare professional for personalized treatment recommendations and cost estimates.

Mirari Cold Plasma Alternative Intervention

Understanding Mirari Cold Plasma

• Safe and Non-Invasive Treatment: Mirari Cold Plasma is a safe and non-invasive treatment option for various skin conditions. It does not require incisions, minimizing the risk of scarring, bleeding, or tissue damage.
• Efficient Extraction of Foreign Bodies: Mirari Cold Plasma facilitates the removal of foreign bodies from the skin by degrading and dissociating organic matter, allowing easier access and extraction.
• Pain Reduction and Comfort: Mirari Cold Plasma has a local analgesic effect, providing pain relief during the treatment, making it more comfortable for the patient.
• Reduced Risk of Infection: Mirari Cold Plasma has antimicrobial properties, effectively killing bacteria and reducing the risk of infection.
• Accelerated Healing and Minimal Scarring: Mirari Cold Plasma stimulates wound healing and tissue regeneration, reducing healing time and minimizing the formation of scars.

Mirari Cold Plasma Prescription

Video instructions for using Mirari Cold Plasma Device – Y82 Hypospadias (ICD-10:Q54.9)

Localized (0) Sacrum (1) Prostate & Uterus (2) Kidney, Liver & Spleen (3) Heart, Bile & Pancreas (4) Lungs (5) Throat, Lymphatic & Thyroid (6) Neuro system & ENT (7)

Use the Mirari Cold Plasma device to treat Hypospadias effectively.

WARNING: MIRARI COLD PLASMA IS DESIGNED FOR THE HUMAN BODY WITHOUT ANY ARTIFICIAL OR THIRD PARTY PRODUCTS. USE OF OTHER PRODUCTS IN COMBINATION WITH MIRARI COLD PLASMA MAY CAUSE UNPREDICTABLE EFFECTS, HARM OR INJURY. PLEASE CONSULT A MEDICAL PROFESSIONAL BEFORE COMBINING ANY OTHER PRODUCTS WITH USE OF MIRARI.

Step 1: Cleanse the Skin

• Start by cleaning the affected area of the skin with a gentle cleanser or mild soap and water. Gently pat the area dry with a clean towel.

Step 2: Prepare the Mirari Cold Plasma device

• Ensure that the Mirari Cold Plasma device is fully charged or has fresh batteries as per the manufacturer’s instructions. Make sure the device is clean and in good working condition.
• Switch on the Mirari device using the power button or by following the specific instructions provided with the device.
• Some Mirari devices may have adjustable settings for intensity or treatment duration. Follow the manufacturer’s instructions to select the appropriate settings based on your needs and the recommended guidelines.

Step 3: Apply the Device

• Place the Mirari device in direct contact with the affected area of the skin. Gently glide or hold the device over the skin surface, ensuring even coverage of the area experiencing.
• Slowly move the Mirari device in a circular motion or follow a specific pattern as indicated in the user manual. This helps ensure thorough treatment coverage.

Step 4: Monitor and Assess:

• Keep track of your progress and evaluate the effectiveness of the Mirari device in managing your Hypospadias. If you have any concerns or notice any adverse reactions, consult with your health care professional.

Note

This guide is for informational purposes only and should not replace the advice of a medical professional. Always consult with your healthcare provider or a qualified medical professional for personal advice, diagnosis, or treatment. Do not solely rely on the information presented here for decisions about your health. Use of this information is at your own risk. The authors of this guide, nor any associated entities or platforms, are not responsible for any potential adverse effects or outcomes based on the content.

Mirari Cold Plasma System Disclaimer

• Purpose: The Mirari Cold Plasma System is a Class 2 medical device designed for use by trained healthcare professionals. It is registered for use in Thailand and Vietnam. It is not intended for use outside of these locations.
• Informational Use: The content and information provided with the device are for educational and informational purposes only. They are not a substitute for professional medical advice or care.
• Variable Outcomes: While the device is approved for specific uses, individual outcomes can differ. We do not assert or guarantee specific medical outcomes.
• Consultation: Prior to utilizing the device or making decisions based on its content, it is essential to consult with a Certified Mirari Tele-Therapist and your medical healthcare provider regarding specific protocols.
• Liability: By using this device, users are acknowledging and accepting all potential risks. Neither the manufacturer nor the distributor will be held accountable for any adverse reactions, injuries, or damages stemming from its use.
• Geographical Availability: This device has received approval for designated purposes by the Thai and Vietnam FDA. As of now, outside of Thailand and Vietnam, the Mirari Cold Plasma System is not available for purchase or use.

References

1. Bouty A, Ayers KL, Pask A, Heloury Y, Sinclair AH. The Genetic and Environmental Factors Underlying Hypospadias. Sex Dev. 2015;9(5):239-259.
2. World Health Organization. International Classification of Primary Care, Second edition (ICPC-2). Geneva: WHO; 2003.
3. World Health Organization. International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). Geneva: WHO; 2019.
4. Springer A, van den Heijkant M, Baumann S. Worldwide prevalence of hypospadias. J Pediatr Urol. 2016;12(3):152.e1-152.e7.
5. van der Zanden LF, van Rooij IA, Feitz WF, Franke B, Knoers NV, Roeleveld N. Aetiology of hypospadias: a systematic review of genes and environment. Hum Reprod Update. 2012;18(3):260-283.
6. Carmichael SL, Shaw GM, Lammer EJ. Environmental and genetic contributors to hypospadias: a review of the epidemiologic evidence. Birth Defects Res A Clin Mol Teratol. 2012;94(7):499-510.
7. Snodgrass W, Bush N. Recent advances in understanding/management of hypospadias. F1000Prime Rep. 2014;6:101.
8. Kalfa N, Philibert P, Sultan C. Is hypospadias a genetic, endocrine or environmental disease, or still an unexplained malformation? Int J Androl. 2009;32(3):187-197.
9. Keays MA, Dave S. Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes. Can Urol Assoc J. 2017;11(1-2Suppl1):S48-S53.
10. Baskin LS, Ebbers MB. Hypospadias: anatomy, etiology, and technique. J Pediatr Surg. 2006;41(3):463-472.