Referat Hipospadia

RHCHRDP LE^F]^D@ED

@e}x}xk Fihl ? Ldk`rd Oxdk`d

CG X^K Shphrdk Odgdrpd

Ahepu

CG X^L ^habeabekj ?

@r+ D}rfce ]+ ]xrdmladk) ]~B^

@H^DRPHAHK BH@DL R]^D@ JDPFP ]FHBRFPF @EPGH]D@ ODGDRPD 2>44

E+

^hk`dlxixdk

^d`d dbd` ~hrpdad) dlie bh`dl `dre Uxkdke Lhief`frx} `dk Dkpeiex}) ~hrpdad!pdad udkj ahidgxgdk ~hkdkjjxidkjdk ~hkdkjjxidkjdk xkpxg le~f}~d`ed+ @eidgxgdk da~xpd}e `dre bdjedk ~hke} `e}pdi `dre ahdpx}+ ]hidkoxpkud mdrd eke `eegxpe fihl Jdihk `dk ^dxix} `dre Djhkped ~d`d pdlxk 2>> `dk pdlxk 0>>+ @x~idu ahaxide hrd af`hrk ~d`d be`dkj eke ~d`d pdlxk 4<:0 `hkjdk aha~hrghkdigdk aha~hrghkdigdk }hmdrd `hpdei rhgfk}prxg}e xrhprd+ ]hgdrdkj) ihbel `dre 2>> phgkeg  phidl `ebxdp `dk }hbdjedk bh}dr ahrx~dgdk axipe!}pdjh rhmfk}prxmpefk7 udkj phr`ere `dre  cer}p hahrjhkmu }pdjh xkpxg ahkjfrhg}e }phkfpem ahdpx} oegd `e~hrixgdk `dk }hmfk` }pdjh

xkpxg ahkjleidkjgdk mlfr`hh `dk rhmxrsdpxa) ghax`edk ~d`d pler` }pdjh udepx xrhlprf~id}pu+ Bhbhrd~d ad}didl udkj bhrlxbxkjdk `hkjdk phgkeg  axipe!}pdjh udepx7 ahabxpxlgdk f~hrd}e udkj axipe~ih7 }hrekj phrod`e ahdpx} pe`dg ahkmd~de xoxkj jidk`} ~hke}7 }hrekj phrod`e }pregpxr dpdx ce}phi xrhprd7 `dk `dre }hje h}phpegd `edkjjd~ gxrdkj bdeg+ ^d`d pdlxk 453>) Lek`hrhr aha~hrghkdigdk phgkeg  fkh!}pdjh rh~der  xkpxg ahkjxrdkje gfa~iegd}e `dre phgkeg  axipe!}pdjh rh~der + Mdrd eke `edkjjd~ }hbdjde rhgfk}prxg}e xrhprd udkj e`hdi `dre }hje dkdpfae `dk cxkj}efkdikud) `dre }hje h}phpeg `edkjjd~ ihbel bdeg) =

gfa~iegd}e aekeadi) `dk ahkjxrdkje }fmedi mf}p + EE+

@hceke}e

Le~f}~d`ed }hk`ere bhrd}di }hk`ere  bhrd}di `dre `xd gdpd udepx ’lu~f‑ udkj bhrdrpe ’`e bdzdl‑ `dk 4

’}~d`fk’ udkj bhrdrpe ghrdpdk udkj ~dkodkj+ Le~f}~d`ed d`didl ghidekdk gfkjhkepdi `eadkd axdrd xrhprd hg}phrkd ,AXH% phrihpdg `e shkprdi ~hke} `dk ihbel gh ~rf|eadi `dre 0

pha~dp kfradikud ,xoxkj jidk` ~hke}%+ Ghidekdk eke }hrekjgdie `e}hrpde d`dkud cebrf}e} ~d`d bdjedk `e}pdi AXH udkj ahkuhbdbgdk bhkjgfgkud ~hke} ,mlfr`dh%+ EEE+

Hpfifje

^hkuhbdbkud ^hkuhbdbkud }hbhkdrkud }dkjdp axipecdgpfr axipe cdgpfr `dk }da~de }hgdrdkj bhixa `eghpdlxe ~hkuhbdb ~hkuhbdb ~d}pe `dre le~f}~d`ed+ Kdaxk) d`d bhbhrd~d cdmpfr udkj fihl ~drd dlie `edkjjd~ ~diekj bhr~hkjdrxl dkpdrd idek ?

=

4+ Jdkjjxdk `dk ghpe`dg}heabdkjdk lfrafk Lfrafk udkj `eadg}x` `e }eke d`didl lfrafk dk`rfjhk udkj ahkjdpxr frjdkfjhkh}e} ghidaek ,~red%+ Dpdx bed}d oxjd gdrhkd rh}h~pfr lfrafk dk`rfjhkkud }hk`ere `e `dida pxbxl udkj gxrdkj dpdx pe`dg d`d+ ]hlekjjd zdidx~xk lfrafk dk`rfjhk }hk`ere phidl phrbhkpxg mxgx~ dgdk phpd~e d~dbeid rh}h~pfrkud pe`dg d`d phpd~ }dod pe`dg dgdk ahabhregdk }xdpx hchg udkj }hah}pekud+ Dpdx hkea udkj bhr~hrdk `dida }ekph}e} lfrafk dk`rfjhk pe`dg ahkmxgx~e ~xk dgdk bhr`da~dg }dad+ 2+ Jhkhpegd Phrod`e gdrhkd jdjdikud }ekph}e} dk`rfjhk+ Ldi eke bed}dkud phrod`e gdrhkd axpd}e ~d`d jhk udkj ahkjgf`h }ekph}e} dk`rfjhk phr}hbxp }hlekjjd hg}~rh}e `dre jhk phr}hbxp pe`dg phrod`e+ =+ Iekjgxkjdk Bed}dkud cdgpfr iekjgxkjdk udkj ahkod`e ~hkuhbdb d`didl ~fixpdk `dk dp udkj bhr}ecdp phrdpfjhkeg udkj `d~dp ahkjdgebdpgdk axpd}e ES+

H~e`haefifje

Le~f}~d`ed ahrx~dgdk ghidekdk bdzddk udkj phrod`e ~d`d = `edkpdrd 4+>>> bdue bdrx idler+ Bhrdpkud le~f}~d`ed bhrsdred}e) ghbdkudgdk ixbdkj xrhprd phrihpdg `e `hgdp xoxkj ~hke}) udepx ~d`d jidk} ~hke}+ Bhkpxg le~f}~d`ed udkj ihbel bhrdp phrod`e oegd ixbdkj xrhprd phr`d~dp `e phkjdl bdpdkj ~hke} dpdx ~d`d ~dkjgdi ~hke}) `dk gd`dkj ~d`d }grfpxa ,gdkpxkj dgdr% dpdx `e bdzdl }grfpxa+ Ghidekdk eke }hrekjgdie bhrlxbxkjdk

`hkjdk mlfr`dh) udepx }xdpx odrekjdk cebrf}d udkj ghkmdkj) udkj ahkuhbdbgdk ~hke} ahihkjgxkj gh bdzdl ~d`d }ddp hrhg}e+ Bdue udkj ahk`hrepd le~f}~d`ed }hbdegkud pe`dg  `e}xkdp+ Gxiep `h~dk ~hke} `ebedrgdk xkpxg `ejxkdgdk ~d`d ~habhkpxgdk xrhprd+ Rdkjgdedk ~habh`dldk ldrx} `ex~dudgdk phidl }hih}de `eidgxgdk }hbhixa dkdg axide }hgfidl+ ^d`d }ddp eke) ~hrbdegdk le~f}~d`ed `edkoxrgdk `eidgxgdk }hbhixa dkdg bhrxaxr 4< bxidk+ S+

2

^dpfce}efifje `dk Adkech}pd}e Gieke}

=

4+ Le~f}~d`ed phrod`e gdrhkd pe`dg ihkjgd~ku i hkjgd~kudd ~hrghabdkjdk xrhprd `dida xphrf+

2+ Le~f}~d`ed `eadkd ixbdkj xrhprd phrihpdg ~d`d ~hrbdpd}dk ~hke} `dk }grfpxa+ =+ Le~f}~d`ed d`didl ixbdkj xrhprd bhraxdrd ~d`d ixbdkj crhkxa) }h`dkj ixbdkj crhkxakud pe`dg phrbhkpxg) pha~dp kfradikud ahdpx} xrekdrex} `epdk`de ~d`d jidk} ~hke} }hbdjde mhidl bxkpx+

2

Jdabdr 4+ Bhkpxg le~f}~d`ed dgebdp ghidekdk jhkhpeg  2

Jhodid Gieke}

4+ Ixbdkj ~hke} pe`dg phr`d~dp `e xoxkj ~hke}) phpd~e bhrd`d ihbel gh ~rf|eadi `dk bhrd`d `e shkprdi+ 2+ ^hke} ahihkjgxkj gh bdzdl+ =+ ^hke} pda~dg }h~hrpe bhrghrx`xkj gdrhkd ~rh~xpexa `ebdjedk shkprdi pe`dg d`d) bhrgxa~xi `ebdjedk `fr}di+ 0+ Oegd bhrghael) dkdg ldrx} `x`xg+ SE+

@edjkf}e}

@edjkf}e} le~f}~d`ed bed}dkud ohid} ~d`d ~hahreg}ddk ek}~hg}e+ Gd`dkj!gd`dkj le~f}~d`ed `d~dp `e`edjkf}e} ~d`d ~hahreg}ddk xiprd}fxk` ~rhkdpdi+ Oegd pe`dg  phre`hkpecegd}e }hbhixa ghidlerdk) adgd bed}dkud `d~dp phre`hkpecegd}e ~d`d ~hahreg}ddk =

}hphidl bdue idler+ ^d`d frdkj `hzd}d udkj ahk`hrepd le~f}~d`ed `d~dp ahkjhixlgdk gh}xiepdk xkpxg ahkjdrdlgdk ~dkmdrdk xrekh+ Mlfr`dh `d~dp ahkuhbdbgdk bdpdkj ~hke} ahihkjgxkj gh shkprdi udkj `d~dp ahkjjdkjjx lxbxkjdk }hg}xdi+ Le~f}~d`ed pe~h ~hrekhdi `dk ~hkf}mrfpdi ahkuhbdbgdk ~hk`hrepd ldrx} aeg}e `dida ~f}e}e `x`xg) `dk le~f}~d`ed ohke} eke `d~dp ahkuhbdbgdk ekchrpeiepd}+ Bhbhrd~d ~hahreg}ddk ~hkxkodkj udkj `d~dp `eidgxgdk udepx xrhplprf}mf~u `dk mu}pf}mf~u xkpxg ahad}pegdk frjdk!frjdk

}hg} ekphrkdi phrbhkpxg }hmdrd kfradi+  H|mrhpfru xrfjrd~lu `eidgxgdk xkpxg ahk`hphg}e d`d pe`dgkud dbkfradiepd} gfkjhkepdi ~d`d jekodi `dk xrhphr+ @edjkf}e} be}d oxjd `ephjdggdk bhr`d}drgdk ~hahreg}ddk ce}eg+ Oegd le~f}~d`ed phr`d~dp `e ~dkjgdi ~hke}) axkjgek ~hrix `eidgxgdk ~hahreg}ddk rd`efifje} xkpxg  ahahreg}d ghidekdk bdzddk idekkud+Bdue udkj ahk`hrepd le~f}~d`ed }hbdegkud pe`dg  `e}xkdp+ Gxiep `h~dk ~hke} `ebedrgdk xkpxg `ejxkdgdk ~d`d ~habh`dldk+ Rdkjgdedk ~habh`dldk `ex~dudgdk phidl }hih}de `eidgxgdk }hbhixa dkdg axide }hgfidl+ ^d`d }ddp eke) `ex~dudgdk `eidgxgdk }hbhixa dkdg bhrxaxr 4< bxidk+ Oegd pe`dg `efbdpe) axkjgek dgdk phrod`e gh}xiepdk `dida ~hidpeldk bxdkj der ~d`d dkdg `dk ~d`d }ddp `hzd}d kdkpe) axkjgek dgdk phrod`e jdkjjxdk `dida ahidgxgdk lxbxkjdk }hg}xdi+ SEE+

Ghidekdk ^hkuhrpd

0

4+ Aegrf~hke} 2+ Xk`h}mhk`x} Xk`h}mhk`x} ph}pe} =+ Ghidekdk jekodi 0+ Ghidekdk xrhphr & xrhprd 8+ Ghidekdk bxie!bxie 3+ Jhk`hr :+ ]mrfpxa bece`d

SEEE+ Gid}ecegd}e

4+ ]xbjidk`xihr 2+ ^hkeih }ldcp =+ ^hkf}mrfpdi 0+ ]mrfpdi 8+ ^hrekhdi

0

Jdabdr :+ Gid}ecegd}e Le~f}~d`ed

E\+

0

^hkdpdidg}dkddk

^hkdkjdkdk le~f}~d`ed d`didl `hkjdk mdrd f~hrd}e+ F~hrd}e eke bhrpxoxdk xkpxg  ahrhgfk}prxg}e ~hke} djdr ixrx} `hkjdk frece}exa xrhprd ~d`d pha~dp udkj kfradi dpdx `ex}dldgdk `ex}dldgdk xkpxg }hkfradi axkjgek+ F~hrd}e }hbdegkud `eidg}dkdgdk ~d`d }ddp x}ed dkdg  udepx hkda bxidk }da~de x}ed ~rd}hgfidl+ Ldi eke `eadg}x`gdk bdlzd ~d`d x}ed eke dkdg  `eldrd~gdk bhixa }d`dr bdlzd ed bhjepx ’}~h}edi‑) `dk bhrbh`d `hkjdk phadk !phadkkud udkj idek udepx `eadkd dkdg udkj idek bed}dkud aeg}e ,bxdkj der }hke% `hkjdk bhr`ere }h`dkjgdk ed }hk`ere }hk`er e ldrx} ahidgxgdkkud `hkjdk ofkjgfg djd xrek pe`dg ’abihbhr‑ gh adkd!adkd+ Dkdg udkj ahk`hrepd le~f}~d`ed lhk`dgkud odkjdk `xix `eglepdk) ldi eke bhrgdepdk `hkjdk pek`dgdk f~hrd}e rhgfk}prxg}e udkj dgdk ahkjdabei gxiep ~rh~xpexa ~hke} xkpxg ahkxpx~ ixbdkj `dre }ximx} xrhprd udkj pe`dg ahkudpx ~d`d ~hk`hrepd 8

le~f}~d`ed+

Pdld~dk f~hrd}e rhgfk}prxg}e dkpdrd idek ?

3

4+ Rhihd}h Mlfr`dh `dk Pxkkhiekj Ahixrx}gdk ~hke} udepx frece}exa `dk mdkdie} xrhprd }hkfradi axkjgek+ Ldi eke `egdrhkdgdk ~d`d ~hk`hrepd le~f}~d`ed bed}dkud phr`d~dp }xdpx mlfr`d udkj ahrx~dgdk odrekjdk cebrf}d udkj ahkjdgebdpgdk ~hke} bhkjgfg+ Idkjgdl }hidkoxpkud d`didl afbeie}d}e ,ahafpfkj `dk ahaek`dlgdk% gxiep ~rh~xpexa ~hke} xkpxg  ahkxpx~ }ximx} xrhprd `dk `ebxdp ixbdkj `e jidk` ~hke} }hlekjjd AXH bhrd`d `e xoxkj ~hke}+ 2+ Xrhprf~id}pu Pdld~ gh`xd eke `eidg}dkdgdk d~dbeid pe`dg phrbhkpxg cf}}d kdcemxidre} ~d`d jidk} ~hke}+ Xrhprf~id}pu udepx ahabxdp cd}}d kdcemxidre} bdrx ~d`d jidk} ~hke} udkj kdkpekud dgdk `elxbxkjgdk `hkjdk mdkdie} xrhprd udkj phidl phrbhkpxg }hbhixakud ahidixe pdld~ ~hrpdad+

Jdabdr <+ ^hrbdk`ekjdk }hbhixa `dk }h}x`dl f~hrd}e

\+

Gfa~iegd}e ^d}md F~hrd}e

2

3

4+ Ce}pxid xrhprfgxpdk) ahrx~dgdk gfa~iegd}e udkj phr}hrekj `dk eke `ejxkdgdk }hbdjde ~drdahphr xkpxg ahkeide ghbhrld}eidk f~hrd}e+ ^d`d ~rf}h`xr f~hrd}e }dpx pdld~ }ddp eke dkjgd ghod`edk udkj `d~dp `ephread d`didl 8!4>( + 2+ H`had&~habhkjgdgdk udkj phrod`e dgebdp rhdg}e odrekjdk bh}drkud `d~dp bhrsdred}e)  oxjd phrbhkpxgkud lhadpfa& gxa~xidk `drdl `ebdzdl gxiep) udkj bed}dkud `emhjdl `hkjdk bdixp phgdk }hidad 2 }da~de = ldre ~d}gd f~hrd}e+ =+ ]pregpxr) ~d`d ~rfg}eadi dkd}pfaf}e} udkj ghaxkjgekdk `e}hbdbgdk fihl dkjxid}e `dre dkd}pfaf}e}+ 0+ @eshrpegxixa) phrod`e ~d`d ~habhkpxgdk khfxrhprd udkj phridix ihbdr) dpdx d`dkud }phkf}e} ahdpdi udkj ahkjdgebdpgdk `eidpd}e udkj idkoxp+ i dkoxp+

8+ Rh}e`xdi mlfr`hh&rhgxrhk mlfr`hh) dgebdp `dre reie} gfr`h udkj pe`dg }ha~xrkd) `eadkd pe`dg ahidgxgdk hrhg}e drpece}edi }ddp f~hrd}e dpdx ~habhkpxgdk }gdr udkj bhrihbeldk `e shkprdi ~hke} zdidx~xk }dkjdp odrdkj+ 3+ Rdabxp `dida xrhprd) udkj `d~dp ahkjdgebdpgdk ekchg}e }dixrdk ghkmekj bhrxidkj dpdx ~habhkpxgdk bdpx }ddp ~xbhrpd}+

\E+

^HKXPX^

Le~f}~d`ed d`didl ghidekdk gfkjhkepdi `eadkd AXH phrihpdg `e shkprdi ~hke} `dk ihbel gh ~rf|eadi `dre pha~dp kfradikud ,xoxkj jidk` ~hke}%+ Le~f}~d`ed ahrx~dgdk ghidekdk bdzddk udkj phrod`e ~d`d = `edkpdrd 4+>>> bdue bdrx idler+ Ghbdkudgdk ixbdkj xrhprd phrihpdg `e `hgdp xoxkj ~hke}) udepx ~d`d jidk} ~hke}+ Bhkpxg le~f}~d`ed udkj phrod`e oegd ixbdkj xrhprd phr`d~dp `e phkjdl bdpdkj ~hke} dpdx ~d`d ~dkjgdi ~hke}) `dk gd`dkj ~d`d }grfpxa ,gdkpxkj dgdr% dpdx `e bdzdl }grfpxa+ Ghidekdk eke }hrekjgdie bhrlxbxkjdk

`hkjdk

gfr`e) udepx }xdpx odrekjdk cebrf}d udkj ghkmdkj) udkj

ahkuhbdbgdk ~hke} ahihkjgxkj gh bdzdl ~d`d }ddp hrhg}e+ Jhodidkud d`didl ? 4+ Ixbdkj ~hke} pe`dg phr`d~dp `e xoxkj ~hke}) phpd~e bhrd`d ihbel gh ~rf|eadi+ 2+ ^hke} ahihkjgxkj gh bdzdl+ =+ ^hke} pda~dg }h~hrpe bhrghrx`xkj gdrhkd ~rh~xpexa `ebdjedk shkprdi pe`dg d`d) bhrgxa~xi `ebdjedk `fr}fi+ 0+ Oegd bhrghael) dkdg ldrx} `x`xg+

@edjkf}e} be}d oxjd `ephjdggdk bhr`d}drgdk ~hahreg}ddk ce}eg+ Oegd le~f}~d`ed phr`d~dp `e ~dkjgdi ~hke}) axkjgek ~hrix `eidgxgdk ~hahreg}ddk rd`efifje} xkpxg  ahahreg}d ghidekdk bdzddk idekkud+Bdue udkj ahk`hrepd le~f}~d`ed }hbdegkud pe`dg  `e}xkdp+ Gxiep `h~dk ~hke} `ebedrgdk xkpxg `ejxkdgdk ~d`d ~habh`dldk+ Rdkjgdedk ~habh`dldk `ex~dudgdk phidl }hih}de `eidgxgdk }hbhixa dkdg axide }hgfidl+ ^d`d }ddp eke) `ex~dudgdk `eidgxgdk }hbhixa dkdg bhrxaxr 4< bxidk+ Oegd pe`dg `efbdpe) axkjgek dgdk phrod`e gh}xiepdk `dida ~hidpeldk bxdkj der ~d`d dkdg `dk ~d`d }ddp `hzd}d kdkpe) axkjgek dgdk phrod`e jdkjjxdk `dida ahidgxgdk lxbxkjdk }hg}xdi+

Rhchrhk}e 4+ ]d}prd}x~hkd ]d}prd}x~hkd L+) Le~f}~d`ed) @dida Gxa~xidk Gxiedl Eiax Bh`dl) Bekdrx~d Dg}drd) Odgdrpd) 4558? 02 Adrhp 2>4> =+ ^xrkfaf B+B+) Xrhprd `dk Le~f}~d`ed) @dida @d}dr!`d}dr Xrfifje) Adidkj) 2>>> ? 3)4=:!4=< 0+ Gxiedl Le~f}~d`ed) ]xb ]AC Bh`dl ^id}peg  @h~drphahk Bh`dl R]^D@ JDPFP ]FHBRFPF) 2>44+ 8+ ]xred`e + Repd) Uxiedke + 2>>4 + D}xldk Gh~hrdzdpdk ^d`d Dkdg + Odgdrpd ? MS+ ]djxkj ]hpf 3+ lpp~?&&idg}laekdzd}d lpp~?&&idg}laekdzd}d}e+bifj}~fp+m }e+bifj}~fp+mfa&2>>8&42&le~f}~d fa&2>>8&42&le~f}~d`ed+lpai `ed+lpai++ @egxpe~ pdkjjdi 4> Adrhp 2>4>