Aprilia Santini Manganang, a soldier who formerly famous and known as Indonesian volley ball player is now officially changed to Aprilio Perkasa Manganang. But he is not a transgender. What then caused this transformation? It is Hypospadias. Recently the term Hypospadias has been sticking out in various circles of media in Indonesia. Both print and online media discuss everything concerning the condition of people with Hypospadias.
Before we highlight Aprilio who are in the public spotlight regarding this condition, let's first identify and understand what Hypospadias is.
(1) Mayo clinic summarized Hypospadias as a birth defect (congenital condition) in which the opening of the urethra is on the underside of the penis instead of at the tip.(2) The urethra is a tube that connects the urinary bladder to the urinary meatus for the removal of urine from the body.
(3)While Centers for Disease Control and Prevention explained that there are three types of Hypospadias;
Subcoronal: The opening of the urethra is located somewhere near the head of the penis.
Midshaft: The opening of the urethra is located along the shaft of the penis.
Penoscrotal: The opening of the urethra is located where the penis and scrotum meet.
Further explained that boys with hypospadias can sometimes have a curved penis. They could have problems with abnormal spraying of urine and might have to sit to urinate.
CAUSES and SYMPTOMS
(4)Most sources informed that researchers don’t know exactly what causes hypospadias. Though it says that this situation mostly run in the family.
As mentioned above that this is a congenital condition, this happened during pregnancy. Normally the penis begins to develop at around the eight week of pregnancy. The urethra defects, that leads to hypospadias, happens between weeks nine and twelve.
Cleveland clinic continues explain that there are certain factors in the mother can increase the risk of the baby having hypospadias, including mothers who:
Carry extra weight (obesity)
Are over age 35
Use fertility treatment to get pregnant (possibly because of exposure to progesterone, a hormone used during fertilization)
Use other hormones before or during pregnancy
Have exposure to pesticides.
Here down the symptoms include:
Chordee: Penis curves downward
Undescended Testicles: One of the testicles doesn’t fully descend into the scrotum (happens in about 10 % cases)
Undeveloped Foreskin: The skin that covers the head of the penis isn’t complete. Babies with hypospadias should not be circumcised.
Abnormal Urination: Urine doesn’t spray in a straight stream
DIAGNOSIS and TREATMENT
When a baby is born, the healthcare providers will do a routine newborn examination. One well known method using is APGAR Score, to check for Appearance, Pulse, Grimace, Activity and Respiration. Checking for hypospadias is part of the routine newborn examination after birth.
When the healthcare providers notice the abnormality of the penis for example; the hole of the penis is in the wrong place, it should reported to the pediatrician and If hypospadias is confirmed then the baby will refer to pediatric urologist for treatment.
Hypospadias treatment is a correction procedure by surgery. Following the medical technology imrpovement, children as young as between six and twelve months can receive the surgery by pediatric urogolist. Further explained by Cleveland Clinic that it is easier to care for the surgery site at such young age and also safer to have anesthesia.
HYPOSPADIAS in INDONESIA
Hypospadias caught the attention of Indonesian citizens when the case and condition about Aprilia Manganang announced officially by the leader of Tentara Nasional Indonesia (TNI) – Indonesia National Army.
Now officially and legally a male, Aprilio Perkasa Manganang is not alone. According to a journal ‘Common Practice of Hypospadias Management by Pediatric Urologists in Indonesia: A Multi-center Descriptive Study from Referral Hospitals’ (2019), there were 591 cases recorded along June – September 2018 (5).
As mentioned above, this condition should be detected as early as possible