PLASTIC SURGERY IN HYPOSPADIAS PATIENTS IN SHARIA MAQASHID REVIEW

Recently, Indonesia has been shocked by the problem of hypospadias patients from a former athlete who is also a soldier in the Indonesian Armed Forces (TNI), second sergeant (serda) AM. Treatment for hypospadias patients is based on the type of disability the patient has. Most hypospadias problems require surgery. Surgery is performed by placing the urethra in the correct position, correcting a sunken penis, and repairing the skin around the urethral opening, as the doctor may need to use the foreskin to make corrections. The purpose of this study is to describe the meaning of hypospadias and plastic surgery for hypospadias patients at the level of maqasid sharia. The methodology in this study uses library methods. From the point of view of the problem being studied, this investigation uses an integrity, philosophical, systematic, and general approach to seek this truth and wisdom or the essence of inquiry. The nature of this investigation is descriptive-analytical. The analytical method used in this investigation is descriptive, comparative, and critical analysis. This study found that hypospadias is a congenital urethral abnormality in male children, which is usually accompanied by an abnormal curvature and size of the penis. The law of plastic surgery for hypospadias patients is permissible because it is included in the collection of protection of religion, mind, soul, lineage, and property as maqasid daruriyyat, which is intended to uphold worldly and hereafter benefits. Hopefully, the results of this investigation will enrich the intellectual treasures for Muslim individuals and the public regarding the law of plastic surgery for hypospadias patients. Destructive poisons are contaminants or materials that are often encountered in everyday life. Exposure to harmful toxins in pregnant women can result in changes such as urogenital malformations, decreased sperm quality and breast cancer. Several studies have shown increasing cases of hypospadias in families who live close to landfills in Europe and mothers who have a history of occupational exposure to harmful toxins have a greater risk of giving birth to children with hypospadias disorders. This study was corroborated by another study which showed that mothers who had a history of eating organic vegetables did not have children with hypospadias disorders.


INTRODUCTION
Surgery is the development of medical science to treat or repair parts of the human body through surgical operations. The science of plastic surgery also aims to treat normal appearance and work and make it perfect in a better condition. Surgery is divided into several special sections such as orthopaedic surgery, urology, neurology, plastic surgery, etc.
The majority of people think that plastic surgery is only oriented to beautify, such as liposuction (liposuction), rhinoplasty (nose surgery), facelift (cheek surgery to tighten), and other surgeries that aim to beautify. On the other hand, the scope of plastic surgery is vast.
Plastic surgery is a matter of beauty and reconstruction, such as burns from burns, disorders that give the impression of the face rather than accidents, congenital disabilities, such as cleft lip, and gender abnormalities.
In Indonesia, plastic surgery has experienced a significant increase, especially for cosmetics. The most frequent requests for plastic surgery are rhinoplasty and breast implants, which are for female patients. Even sex swap plastic surgery is also starting to spread because celebrities support it in the entertainment world. These cases have urged the Indonesian Ulema Council to issue a fatwa on plastic surgery. The stipulation of haram law is also for the act of helping people change their gender. This is also following the rules of fiqh, which is included in the prohibition if there is a prohibition on cases that support something. Some consider surgery as an absolutely forbidden prohibition by referring textually to the words of Allah Subhanahu wa Ta'ala in the Qur'an surah al-Nisa' verse 119: And I will mislead them, and I will arouse in them [sinful] desires, and I will command them so they will slit the ears of cattle, and I will command them so they will change the creation of Allah." And whoever takes Satan as an ally instead of Allah has certainly sustained a clear loss. Treatment for hypospadias patients depends on the type of disability the patient has.
Most cases of hypospadias require surgery. Usually, surgery is performed when the patient is 18 months old or at least three months old. It is found in some surgeries that it is done several times gradually. Surgery is intended, among others, by placing the urethra in a suitable place, repairing a sunken penis, repairing the skin of the penis around the urethra because the doctor may need to use the foreskin to carry out corrective actions.
As Muslims who are obliged to adhere to Islamic law in all their activities, surgery on hypospadias patients should be a phenomenon that requires an Islamic legal perspective, because hypospadias is not the same thing as transgender or gender swap surgery. Where transgender is a concept disorder in the identity of a man who prefers to show the role of women in everyday life, so here first it is appropriate to know what the purpose of hypospadias plastic surgery is to be able to know the law. As scholars say:

‫احلكم‬ ‫ابإلسم‬ ‫منوط‬
"A law depends on its name ". 4 From the background, the study of plastic surgery of hypospadias patients, which was stirred up in the discussion of the Indonesian people, became something interesting to be used as a study with the level of Maqasid Syari'ah according to the implementation of hypospadias plastic surgery which can be mistaken for reconstruction or cosmetics. This research is library research, namely: a series of activities relating to collecting library data, reading, recording, and summarizing the research material. 5 Sources of investigation are not limited to books or books but also documentation, the internet, magazines, journals, and newspapers. Library research aims to get various theories, evidence, laws, views, principles, ideas, and so on. Which can analyze and solve the problem being studied. 6 That is research by examining various independent studies related to the subject being studied. The final result of the investigation is to find the law against the problem that has been described.

METHODS
The researcher, in this case, applies two data sources, namely primary data and secondary data. From the perspective of the problem being studied, this investigation uses an integrative approach that discusses the level of need. Philosophical approach, namely thinking deeply, systematically, and in general to find the core of truth and wisdom or the essence of research. 7 While the nature of the research, the researcher uses analytical descriptive to describe hypospadias and the law of plastic surgery for hypospadias patients at the level of maqasid Syari'ah to obtain comprehensive and solid information. Because this research is library research, collecting data can be practised by combining interviews, observations, and analysis in data collection. 8

RESULT AND DISCUSSION
Based on the author's findings, there are three models of plastic surgery in the medical world about sex surgery, sex exchange surgery, sex repair or refinement surgery, and surgical removal of one of the multiple sexes. In this paper, the author will only describe the surgical repair or refinement of sex. Galen was a doctor from Greece and became a gladiator doctor and a personal physician to Emperor Marcus Aurelius in Rome, and he was the first to mention the word hypospadias. The word hypospadias is taken from the Greek "Hypo," which means under, and "Spadon," which means abyss. Hypospadias is one of the most common congenital disabilities in men and the most common defect in penis development. 9 Hypospadias is a congenital disability in the form of an opening of the urethra (urinary tract from the bladder that exits the body), which is located on the ventral (stomach) and proximal (closer to the trunk or base) tip of the penis. In hypospadias, there is no ventral prepuce (a fold of skin that covers the tip of the penis) so that the dorsal prepuce (the backside of a body part) becomes excessive (dorsal hood) and has a chordee habit (the penis moves obliquely to the abdomen). Sometimes there is urethral meatus stenosis (narrowing of the urinary tract from the bladder out of the body), and congenital anomalies such as maldescent testis (insensitive reproductive organs) or inguinal hernia (protrusion of organs, such as the intestines and tissue in the abdomen into the groin area).The urethral meatus is located from the glandular (glands) to the perineal (part of the body). 10 Some explain hypospadias as an abnormality in the location of the urethra and include a congenital abnormality found in boys, which is characterized by the anatomical position of the opening of the urinary tract on the ventral or anterior part of the penis, usually with a concave penis and shorter size than ordinary men. Its location is quite diverse around the ventral part of the penis or in the perineum due to the urethral plate attachment failure. Severe hypospadias is defined as a state of hypospadias accompanied by the external urethral opening between the proximal penis to the junction of the penis and scrotum and has chordees. 11 The general population of hypospadias varies from 0.37 to 41/10000 male infants. Studies in the United States report that cases are more common in whites than blacks. In Finland, cases are lower at 5/10000 compared to other Scandinavian countries at 14/10000 infants. The incidence of hypospadias accompanied by cryptorchidism is 9%, but it is 32% in posterior hypospadias. 12 There is also a study of hypospadias about 3.8 out of 1000 births, meaning that 1 in 300 boys suffer from hypospadias. 13 Cases of hypospadias in Western countries have increased and are estimated to occur in 150-300 male births. 14 Another study states that hypospadias is a congenital malformation in children, while adults have an abnormal sperm count. Other researchers say that sperm quality is not good, testicular cancer, and testicles do not descend. Hypospadias is the underlying cause of the increase in cases of Testicular Dysgenesis Syndrome (TDS). There were no physical problems associated with hypospadias in newborns or adolescents. However, in adult males, chordee will prevent sexual intercourse, penoscrotal or perineal hypospadias can cause infertility, meatal stenosis, difficulty in the flow of urine and cryptorchidism is also common. 15

Factors causing hypospadias
From several studies on hypospadias, it is stated that the cause of hypospadias has not been

Endocrine Factor
The most potential cause of hypospadias is endocrine factors because androgens strongly influence the shape of the urethra in men, so there is a possibility that the leading cause of hypospadias is androgen metabolism disorders.

Genetic Factors
Cases of hypospadias patients from patients who have a father with hypospadias is also 7%. Hypospadias cases without a sibling or family history of hypospadias were 12%. If a family with two people sufferers of hypospadias and one of them is the father, then having a child with hypospadias increases to 26%. Hypospadias cases were found to be 8.5 more likely to be monozygotic twins. Most mutations occur in individuals with proximal hypospadias, and this case shows that proximal hypospadias has a more monogenic or polygenic etiology, while distal hypospadias has a multifactorial aetiology. The prominent candidate genes for hypospadias are those involved in external male genital development, and mutations are present in more than 60 genes involved in genital development.

Environmental factor
Several studies reported a relationship between premature infants, low birth weight (LBW) infants, maternal age during pregnancy, and a history of maternal hypertension with hypospadias. The relationship between prematurity and LBW with the incidence of hypospadias, from the univariate analysis of prematurity and LBW,influences cases of hypospadias. LBW can signify fetal growth restriction because the mother's placenta lacks enough nutrients, and hCG production is also reduced, affecting androgen synthesis.
Maternal age during pregnancy has a relationship with the incidence of hypospadias; the tendency of hypospadias is 4.17 times higher in mothers with ages exceeding 35 years.
Mothers who are pregnant at more than 35 years have a weak placental blood flow as a risk due to spasm of the blood vessels. So, nutrients cannot reach the fetus properly, resulting in an inhibition of fetal growth and metabolism.A vegetarian diet carried out during pregnancy showed statistical results that were not associated with hypospadias.
Some literature states a relationship between the incidence of hypospadias and environmental exposures related to chemicals, namely destructive toxins, chemicals that can affect the development and maturation of sexual function and fetal reproduction. Europe and mothers who have a history of occupational exposure to harmful toxins have a greater risk of giving birth to children with hypospadias disorders. This study was corroborated by another study which showed that mothers who had a history of eating organic vegetables did not have children with hypospadias disorders.

Plastic Surgery for Hypospadias Patients at the Maqashid Syariah Level
In general, it is often formulated that establishing Islamic law is to realize the benefit of humans in the world and the hereafter by utilizing all potential goodness and preventing or rejecting all things that are useless for life and lead to evil. 18 It can be concluded that the purpose of establishing Islamic law is to maintain the benefits and prevent the harm of human life both spiritually and physically, individually and socially.
The purpose of Islamic law can also be referred to as maqasid shari'ah. Maqasid sharia is formed from 2 words maqasid and sharia. Maqasid is the plural word of maqsad(Arabic; ‫)مقصد‬ which means intent and purpose, while sharia is the provisions and laws of Allah that are set to guide humans to achieve happiness in the world and the hereafter. 19 The essence of the application of sharia is to realize the benefits and benefits for humans. This benefit can be realized if the five main elements can be realized and perpetuated. The five main elements, said Sheikh al-Syatibi, are guarding the soul, mind, lineage, property and religion. To realize and maintain this main element, Sheikh al-Syatibi divides it into three objective stages of maqasid or sharia objectives 20 : benefits necessities, Based on the type of plastic surgery in general,with a study of application and definition divided into cosmetics and reconstruction, hypospadias patients also relate to these two types of plastic surgery in the legal study of plastic surgery. As it is easy to understand reconstructive surgery as an attempt to return the individual to a normal state, and cosmetic surgery as an attempt to go beyond his usual limits, so the legal studies are adapted to maqasid sharia (looking at the influence in a person's life, the scope and strength of the argument). And the basic principles of the Shafi'i school by emphasizing that the benefits of necessities must take precedence over the benefits of hajiyyat and the benefits of goods must prioritize improvements and the benefits that are whole/integrate must be prioritized over partial benefits and definitive benefits take precedence over the benefits that are presumptive and delusional. This adjustment is based on the principles of the Shafi'i school of fiqh

‫مب‬ ‫أَلمور‬ ‫قاصدها‬ "all actions depend on the intention." 24
Hypospadias is a case that causes harm to patients who experience it, even though it is natural and not attempted. Moreover, technological support and the development of medical science can support plastic surgery for hypospadias patients to eliminate the dangers of a more definite cure. As the basic principles of the Shafi'i school: The purpose of the harm that should be removed is the harm that has occurred. Therefore, something that has become harmful or may become harmful in the future must be abolished. 26 The maqasid sharia theory is also supported by the following principles:

‫ال‬ ‫يز‬ ‫الضرر‬
‫املصاحل‬ ‫جلب‬ ‫على‬ ‫مقدم‬ ‫املفاسد‬ ‫درؤ‬ "Preventing harm takes precedence over bringing benefits ." 27 This rule understands that if disagreements between things can lead to good and damage, then its implementation should prioritize preventing damage rather than getting a few benefits. 28 Therefore, it is a disadvantage for hypospadias patients to allow plastic surgery because this case may be included in the collection of maintenance of the soul, lineage, mind, property, and religion as the purpose of the need to uphold worldly and hereafter benefits so that if plastic surgery is not performed for hypospadias patients, it is possible to cause a steady loss of benefit in the sense of being disturbed in carrying out the obligatory duties of a mukallaf. What distinguishes the level of necessities from goods is their influence on human life. However, in this situation, plastic surgery is needed to provide convenience and eliminate difficulties in the life of the mukallaf such as plastic surgery that can improve the benefits and functions of the limbs, for example, which realizes the effort of the mukallaf to return to a normal state of health.
Unlike the case with plastic surgery in the level of improvement because in this condition, the mukallaf improves his appearance from the standard of health, in the sense that without doing plastic surgery, it will not interfere with his life. It is just doing plastic surgery to exaggerate his appearance. Even if those who perform plastic surgery at the improvement level are people from low-class economic groups, then this attitude will hit the benefit of property. 29 Therefore, in determining the benefit, it must always lead to the intention of the sharia, Allah Subhanahu wa ta'ala, as the Wisest Substance.
The study of maqasid sharia in the level of maintaining al-usul al-Khamsah: mind, soul, lineage, property and religion regarding plastic surgery for hypospadias patients is as described below: Plastic surgery for hypospadias patients to correct or perfect gender from a religious perspective for a hypospadias patient is following the orders of the Prophet sallallaahu 'alaihi wa sallam, namely the command to seek treatment:  Plastic surgery of hypospadias patients for sex enhancement and improvement in maintaining offspring can be a solution rather than a barrier in achieving the goal of marriage due to deficiencies and defects in the form of the sexes and their functions. So by doing plastic surgery for hypospadias patients, it will help refine and improve sex so that it can solve the case of getting offspring.
Plastic surgery of hypospadias patients for the improvement and improvement of sex from the side of property protection may be a solution for patients in avoiding disputes regarding inheritance because the condition of hypospadias patients is sometimes unacceptable as a man and this case makes hypospadias patients unable to maintain their inheritance rights at the level of a man. Then plastic surgery can guarantee the legal certainty of inheritance rights received by hypospadias patients as the level of a man.

CONCLUSION
From the description above, it can be concluded that: 1. Hypospadias is a congenital birth defect in the form of openings of the urethra (urinary tract from the bladder that exits the body), which is located in the ventral (stomach) and proximal (closer to the trunk or base) tip of the penis. In hypospadias, there is no ventral prepuce (the fold of skin that covers the tip of the penis), so the dorsal prepuce (the backside of a body part) becomes dorsal (dorsalhood) and often coincides with chordee (the penis moves obliquely to the abdomen). Sometimes there is urethral meatus stenosis (narrowing of the urinary tract from the bladder out of the body) and congenital anomalies in the form of a maldescent testis (insensitive reproductive organ) or inguinal hernia (protrusion of organs, such as the intestines and tissues in the abdomen, into the groin area). The urethral meatus is located from the glandular (glands) to the perineal (part of the body).
2. The factors causing hypospadias have not been clearly explained. However, among several studies, some say it is multifactorial due to single gene mutations, single-gene expression disorders, or gene expression disorders-other factors involved in the occurrence of this hypospadias disorder, namely endocrine, genetic and environmental factors. Hypospadias may occur due to one of these factors or a combination of these three factors.
3. Plastic surgery for hypospadias patients is permissible because it is included in maintaining religion, reason, soul, lineage and property as maqasid daruriyyat to uphold