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Penyebab, Gejala dan Cara Mengatasinya


Ada beragam kondisi cacat lahir pada bayi yang sebaiknya diwaspadai oleh setiap orang tua. Misalnya, hipospadia, salah satu kondisi yang bisa terjadi pada bayi laki-laki.

Ada beberapa hal yang perlu Parents ketahui terkait dengan hipospadia pada bayi. Apa saja?

Apa Itu Hipospadia?

Hipospadia: Penyebab, Gejala dan Cara Mengatasinya

Hipospadia merupakan cacat lahir yang terjadi pada penis bayi laki-laki, khususnya pada lubang atau pembukaan uretra. Uretra menjadi organ yang sangat penting bagi proses pengeluaran urine dari kandung kemih.

Penis berfungsi untuk mengeluarkan urine dan sperma dari dalam tubuh. Urine dan sperma keluar melalui penis melalui sebuah saluran yang bernama uretra.

Bila biasanya uretra terletak di ujung atau kepala penis. Namun, pada kondisi ini, pembukaan uretra terletak di bawah. Pada kondisi yang lebih jarang, lubang ini bisa terdapat di bawah skrotum.

Ada beberapa kasus hipospadia dari yang ringan serta beberapa yang lebih parah. Kondisi ini membentuk penis yang tidak berfungsi dengan baik dan tidak terlihat normal.

Dalam kebanyakan kasus, kondisi ini adalah satu-satunya masalah perkembangan pada bayi dan tidak berpengaruh pada kondisi sistem kemihnya atau organ lain.

Kondisi ini cukup umum dan kebanyakan tidak menyebabkan kesulitan dalam merawat bayi. Untuk mengembalikan penampilan normal penis anak biasanya dibutuhkan pembedahan.

Penanganan yang tepat dapat bermanfaat agar anak memiliki organ reproduksi yang normal.

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Jenis Hipospadia

Dilansir dari NYU Langone Hospitals, jenis hipospadia yang dimiliki anak laki-laki tergantung pada lokasi pembukaan uretra:

Hipospadia Distal

Ketika pembukaan uretra terletak di tengah antara tepi kepala dan bagian tengah sisi penis, anak tersebut mengalami hipospadia distal. Penis mungkin sedikit melengkung selama ereksi.

Hipospadia Glanular

Pada kondisi ini, pembukaan uretra anak laki-laki terletak di kepala penis, tetapi tidak di ujungnya. Ini adalah bentuk paling ringan dan paling umum, dan mungkin tidak memerlukan koreksi bedah, karena tidak menyebabkan aliran urin salah arah atau penis bengkok saat ereksi.

Hipospadia Subcoronal

Pada hipospadia subcoronal, pembukaan uretra anak laki-laki terletak tepat di bawah kepala penis. Penis mungkin sedikit melengkung selama ereksi.

Hipospadia Midshaft

Pada hipospadia midshaft, pembukaan uretra anak laki-laki terletak di tengah sisi penis. 

Hipospadia Penoscrotal

Pada hipospadia penoscrotal, bukaan terletak di tempat pertemuan poros dengan skrotum. Anak laki-laki dengan kondisi ini memiliki kelengkungan penis yang lebih menonjol saat ereksi.

Hipospadia Perineal

Pada hipospadia perineal, skrotum terbagi secara tidak normal dan pembukaan uretra terletak di sepanjang bagian tengah kantung yang terbagi. Skrotum yang terbagi, atau bifid, direkonstruksi sehingga ada kantung skrotum tunggal yang tampak normal, dan kelengkungan penis, yang cenderung signifikan, juga diperbaiki.

Penyebab 

hipospadia

Dalam kebanyakan kasus, para ahli belum mengetahui penyebab pasti dari kondisi ini. Kondisi ini biasanya memang terjadi sejak lahir, tetapi faktor lingkungan ditengarai menjadi faktor lain yang memengaruhi.

Berikut adalah beberapa penyebabnya. 

1. Masalah Hormon Selama Kehamilan

Secara prosesnya, kondisi ini bisa terjadi sejak masa kehamilan, khususnya saat proses perkembangan jenis kelamin. Pembentukan penis pada janin terjadi antara minggu ke-9 dan 12 pada kehamilan.

Selama waktu itu, hormon memerintahkan tubuh untuk membentuk uretra dan kulup penis. Adanya permasalahan pada hormon ketika kehamilan ini menyebabkan janin kemudian mengalami perkembangan uretra yang abnormal.

Pada bayi yang mengalaminya, ketika ia tumbuh dalam rahim, jaringan di bagian bawah penis yang merupakan bagian dari uretra tidak menutup. Selain itu, kulit khatan tidak sepenuhnya berkembang dan menyebabkan terjadi kulup ekstra di sisi atas penis, dan tidak ada kulup di bagian bawah penis.

2. Faktor Genetik

Pada sekitar 7 dari 100 anak yang mengalami hipospadia, ayahnya juga memiliki kondisi yang sama. Peluang anak kedua lahir dengan kondisi tersebut adalah sekitar 12 dari 100.

Apabila ayah dan anak laki-laki pertama menderita hipospadia, risiko anak laki-laki kedua mengalami hal yang sama meningkat menjadi 21 dari 100 kasus.

3. Kondisi Ibu Saat Hamil

Beberapa penelitian menunjukkan adanya peningkatan risiko pada bayi laki-laki yang lahir dari ibu yang berusia lebih tua dari 35 tahun, dan juga dari ibu yang dianggap obesitas.

Kemudian ada beberapa spekulasi tentang hubungan antara hipospadia dan paparan hormon atau senyawa tertentu seperti pestisida atau bahan kimia industri pada masa kehamilan. Namun, untuk mengonfirmasi hal ini masih dibutuhkan penelitian lebih lanjut.

Selain itu, perempuan yang menggunakan teknologi reproduksi berbantu seperti IVF dan mengonsumsi hormon tertentu sebelum atau selama kehamilan juga dinilai memiliki risiko lebih tinggi memiliki bayi dengan hipospadia.

Gejala

Penting bagi Parents untuk mewaspadai beberapa hal yang menjadi gejala khas hipospadia sejak dini.

1. Memiliki Lubang Uretra di Bawah Penis

Pada umumnya, gejala khusus anak penderita hipospadia adalah memiliki lubang uretra yang terletak di bagian bawah penis, bukan di ujungnya.

Dalam kebanyakan kasus, pembukaan uretra berada di dalam kepala penis. Ada pula yang memiliki lubang di tengah atau pangkal penis, bahkan di dalam atau di bawah skrotum.

2. Gejala Lainnya

Gejala lainnya dapat berbeda dari satu anak dan yang lainnya, tetapi tanda-tandanya mencakup:

  • Tampilan kulup dan penis yang tidak normal, misalnya hanya bagian atas penis yang ditutupi oleh kulup
  • Arah aliran urine yang tidak normal
  • Ujung penis melengkung ke bawah

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Diagnosis

hipospadia

1. Saat Bayi Baru Lahir

Kondisi ini paling banyak didiagnosis segera setelah bayi lahir. Dokter akan mengamati tampilan penis anak, misalnya jika ternyata lubang uretra tidak terlihat pada tempatnya yang normal, kulup yang tidak sepenuhnya terbentuk di bagian bawah, dan lain-lain. Dokter juga biasanya akan melihat kondisi saat bayi buang air kecil dan saat penisnya ereksi.

Pada beberapa kasus, bayi baru lahir memiliki kulup yang abnormal meski lubang uretra yang normal. Ada pula kasus di mana kulupnya menyembunyikan lubang yang abnormal.

Ada sekitar 8 dari 100 anak laki-laki pengidap hipospadia yang memiliki testis yang belum turun sepenuhnya ke skrotum.

2. Anak Anak Sudah Besar

Jika hipospadia baru diketahui saat anak sudah besar, segeralah berkonsultasi ke dokter. Dokter mungkin akan bertanya mengenai riwayat kesehatan anak, riwayat kesehatan keluarga, dan memberikan pemeriksaan fisik.

Berdasarkan tempat pembukaan atau lubang uretra, terdapat tiga jenis kondisi hipospadia, di antaranya:

  • Subcoronal yakni saat lubang berada di dekat kepala penis
  • Penoscrotal yaitu letaknya di antara penis dan skrotum, atau memang pada skrotum
  • Midshaft yaitu lubang berada di sepanjang batang penis

Artikel terkait: 5 Jenis penyakit autoimun yang rentan terjadi pada anak, catat Parents!

Faktor Risiko Hipospadia pada Bayi

Seorang bayi lebih berisiko terkena hipospadia jika memiliki faktor risiko seperti berikut ini:

  • Memiliki ibu yang berusia 35 tahun ke atas
  • Memiliki ayah yang bermasalah dengan saluran kemih atau alat kelamin
  • Lahir prematur
  • Berat badan lahir rendah
  • Lahir kembar
  • Memiliki ibu yang menderita diabetes selama kehamilan atau diabetes gestational
  • Terpapar asap rokok dan pestisida sebelum lahir
  • Lahir dari teknologi reproduksi berbantu di mana ibu mengonsumsi hormon sebelum dan selama kehamilan

Cara Mencegah

Hipospadia: Penyebab, Gejala dan Cara Mengatasinya

Pada ibu hamil ada beberapa upaya yang diketahui bisa menurunkan risiko kondisi ini, di antaranya:

  • Menghindari beberapa hal yang menjadi faktor penyebab seperti kehamilan di usia 35 tahun
  • Tidak merokok maupun mengonsumsi alkohol
  • Menjaga berat badan tetap ideal selama kehamilan
  • Rutin berkonsultasi dengan dokter
  • Mengonsumsi 400-800 mikrogram asam folat per hari

Komplikasi

Meskipun hipospadia merupakan kelainan cacat lahir pada bagian vital, secara umum kondisi ini tidak perlu penanganan ekstra tetapi tetap diperlukan pengobatan segera untuk menghindari terjadinya komplikasi

Terkait dengan beragam komplikasi yang bisa muncul, jika kondisi ini tidak diobati, beberapa komplikasi jangka pendek dan jangka panjang yang bisa terjadi antara lain:

  • Anak bisa mengalami masalah toilet training atau belajar menggunakan toilet
  • Penis memiliki tampilan yang abnormal
  • Saat ereksi kelengkungan penis berbentuk tidak normal
  • Terdapat masalah dengan ejakulasi

Dengan pengobatan dan perawatan yang tepat, penis si kecil bisa tetap berfungsi secara normal dan sehat.

Masalah yang paling umum terjadi setelah operasi adalah lubang yang terbentuk di tempat lain pada penis, yaitu jalur baru yang terbentuk dari uretra ke kulit.

Selain itu, bekas luka juga bisa terbentuk di saluran atau lubang uretra sehingga mengganggu proses buang air kecil. Hal ini ditandai dengan gejala keluarnya urine dari lubang kedua dan aliran urin yang lambat setelah operasi. Jika terjadi seperti ini segeralah berkonsultasi kepada dokter.

Bisakah Melakukan Pengobatan Hipospadia di Rumah?

Hipospadia: Penyebab, Gejala dan Cara Mengatasinya

Sumber: Pexels

Pengobatan hanya bisa dilakukan oleh tenaga medis dengan melakukan pembedahan. Melansir situs Cleveland Clinic, anak-anak dapat menjalani operasi korektif pada usia yang lebih dini. Penyedia layanan kesehatan akan mendiskusikan waktu yang tepat untuk operasi anak Anda.

Kapan Harus ke Dokter?

Parents perlu menemui dokter jika melihat gejala-gejala yang mengarah pada hipospadia seperti telah dijelaskan di atas.

Perawatan dan pengobatan akan tergantung pada gejala, usia, dan kesehatan umum anak. Sebagian besar kasus ini  memerlukan operasi untuk memperbaiki kecacatan yang ada.

Biasanya operasi dilakukan saat anak laki-laki berusia antara 3 hingga 18 bulan, di mana pertumbuhan penis sedang minimal. Bayi yang memiliki hipospadia tidak boleh disunat saat lahir karena kulup penis mungkin diperlukan untuk memperbaiki penis.

Tujuan operasi adalah untuk membuat penis yang normal dan lurus, dengan saluran kemih yang berakhir pada ujung penis. Operasi tersebut melibatkan 4 langkah yaitu

  • Meluruskan poros penis
  • Membuat saluran kencing
  • Memosisikan lubang uretra di kepala penis
  • Menyunat atau merekonstruksi kulup penis.

Pada dasarnya operasi hipospadia bisa dilakukan saat anak sudah memasuki masa kanak-kanak hingga dewasa. Jika kondisi hipospadia disertai dengan kondisi lain seperti mikropenis atau penis kecil, mungkin pasien akan disarankan terlebih dahulu mendapatkan pengobatan hormon testosteron sebelum operasi.

Operasi yang berhasil hasilnya akan berlangsung seumur hidup. Selain itu, jika dilakukan saat bayi, hasilnya akan menyesuaikan saat penis tumbuh di masa pubertas.

Biaya Operasi Hipospadia

Di Indonesia, estimasi biaya operasi hipospadia berkisar mulai dari Rp 20 hingga Rp 60 juta. Bahkan kabarnya, operasi ini termasuk dalam bedah rekonstruksi  sehingga dapat ditanggung oleh asuransi kesehatan, seperti BPJS Kesehatan. Namun untuk pastinya, pasien diharapkan untuk berkonsultasi dengan petugas terkait.

Pertanyaan Populer Terkait Hipospadia

Meski termasuk penyakit yang langka karena diperkirakan hanya memengaruhi sekitar satu dari 200 anak laki-laki, banyak orang yang bertanya-tanya apa sebenarnya penyakit ini. Beberapa di antara pertanyaan tersebut adalah:

Seperti apa bentuk hipospadia?

Hipospadia umumnya memiliki bentuk khas, yaitu adanya pembukaan uretra di lokasi selain ujung penis, penis melengkung ke bawah (chordee), penampilan penis yang terselubung karena hanya setengah bagian atas penis yang ditutupi oleh kulup.

Hipospadia cewek apa cowok?

Umumnya, kondisi ini dialami oleh anak laki-laki. Namun, deformitas ini juga bisa terjadi pada anak perempuan, tetapi jarang terdiagnosis karena dokter tidak mengetahui dengan baik tentang hipospadia wanita.

Apakah penderita hipospadia bisa punya anak?

Hipospadia tidak secara langsung menyebabkan infertilitas. Namun, laki-laki dengan kondisi ini dapat tidak memiliki anak, karena aliran urine dan sperma dapat terhambat yang menyebabkan ketidaksuburan (infertilitas).

Hipospadia apakah berbahaya?

Pada beberapa anak laki-laki, testis belum sepenuhnya turun ke dalam skrotum. Jika hipospadia tidak diobati dapat menimbulkan masalah di kemudian hari, seperti kesulitan melakukan hubungan seksual atau kesulitan buang air kecil sambil berdiri.

Apakah hipospadia bisa mengeluarkan sperma?

Dengan adanya kelainan lubang penis dan testis tidak teratur, penderitanya mungkin tidak dapat menghasilkan sperma yang layak dan mengalami kesulitan ejakulasi.

Berapa biaya untuk operasi hipospadia?

Estimasi biaya operasi hipospadia berkisar mulai dari Rp 20 hingga Rp 60 juta.

Operasi hipospadia umur berapa?

Perbaikan hipospadia paling sering dilakukan saat anak laki-laki berusia antara 6 bulan hingga 2 tahun. Operasi dilakukan sebagai pasien rawat jalan karena dilakukan secara bertahap. Biasanya akan ditangani oleh ahli urologi anak, ahli anestesi anak, serta perawat anak.

Apakah bisa operasi hipospadia dengan BPJS?

Kabarnya, operasi ini termasuk dalam bedah rekonstruksi  sehingga dapat ditanggung oleh asuransi kesehatan, seperti BPJS Kesehatan. Namun untuk pastinya, pasien diharapkan untuk berkonsultasi dengan petugas terkait.

Berapa kali operasi hipospadia dilakukan?

Operasi mungkin merupakan prosedur satu atau dua tahap berdasarkan tingkat keparahan. Jika anak mengalami hipospadia ringan, biasanya mereka hanya memerlukan perbaikan dalam satu tahap atau satu kali operasi. Namun, jika anak memiliki hipospadia penoscrotal, mereka memerlukan perbaikan dalam dua tahap yang biasanya berjarak enam bulan.

Berapa lama masa penyembuhan operasi hipospadia?

Anak mungkin memerlukan kateter urine selama 5 sampai 14 hari setelah operasi. Beberapa anak pulih sepenuhnya setelah sekitar enam minggu. Ini tergantung pada kondisi kesehatan sang anak. 

Nah, Parents jangan lupa untuk selalu mengecek kondisi si kecil, ya. Itulah beberapa informasi mengenai kelainan hipospadia pada bayi yang perlu diwaspadai, semoga bermanfaat!

***

Artikel diupdate oleh: Nikita Ferdiaz

 

 

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