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Pediatric – Hypospadias

Mostly, boys are born with a fully functioning penis. At times, some congenital (birth) disorders can result in a malformed and malfunctioning penis. This can cause extreme disruption in the functioning and use of the penis by the child.

Normally, the penis serves as the channel to excrete urine and ejaculate semen from the body. The normal opening of the urethra (at the tip of the penis), also called the ‘meatus’, needs to be above the glans (head of the penis). Initially, after since birth, the foreskin covers the glans of the penis and cannot be usually pulled back until the child hits puberty.

The development of the penis takes place in the period between weeks 9 and 12 of the pregnancy. In this period, the male hormones stimulate the formation of the foreskin and the urinary channel. A problem in the hormonal action in this period results in malformation of the penis, causing Hypospadias.

This is a common enough birth disorder and is seen in at least 1 out of 2 children. Hypospadias causes limited or abnormal formation of the urethral opening on the tip of the penis. This results in the urethral opening being formed in the portion beneath the glans, causing distal Hypospadias. It may also be positioned mid-way along the penis or even at the base of the penis, causing proximal Hypospadias. This condition often results in mild to severe curvature in the penis.

Hypospadias is normally detected at birth by the abnormal positioning of the urethral opening and the limited development of the foreskin (dorsal hood).

What is the treatment method for Hypospadias?

Surgical correction has been the conventional form of treating Hypospadias from more than two centuries. Today, there are several surgical approaches that are used worldwide to surgically correct Hypospadias.
The main aim of this surgical procedure is to form a straight penis with normal urethral opening. This may be performed in four steps:

• Straighten the penile shaft

• Create urinary channel

• Position the urethral opening correctly

• Circumcising/reconstructing the foreskin

This procedure is of a short duration, but may be done in separated stages in special circumstances. Doctors mostly advise this surgical repair to be done on affected boys between the ages of 3 months to 18 months.

What is the outcome of Hypospadias treatment like?

The surgeon or urologist will advise you about the post-surgical precautions that you will need to take. In some cases, the doctor may keep a catheter attached for a few days following the surgery which helps to drain the urine and avoid using the freshly formed urethral channel or opening. The doctor may also prescribe antibiotics for a few days to prevent the risk of infection in the operated area.

This surgery is advisably done in the younger ages to prevent excess discomfort to the child. Modern surgical treatment of Hypospadias helps to create a normal and fully functional penis. There is less than 10% chance of complications from this treatment method.

As the most intricate and important part of the whole surgery is creating a normal urethral opening, the incision used for making this may develop scarring in some cases. This can cause hindrance with normal passage of urine. In case of leakage from another hole, an expert pediatric urologist should be immediately consulted.
Most of the complications are detected within the first couple of months following the surgery. However, there are rare instances when the surgery may result in development of fistulas or blockages after a few years. Most of the common complications are also effectively corrected with surgical treatment.

The surgeon or urologist will advise you on the period of time for bed rest and when you can re-join work. Regular check-up are also advised following the surgery to detect complications and to ensure the success of the surgical repair.

Frequently asked questions:

Can genetic factors cause Hypospadias?

Around 7% of patients have proven to have a family member (usually the father) to have suffered from Hypospadias as well. The risk increases as the number of the affected rises in the immediate family.

Is it important to treat Hypospadias?

Patients often enquire whether a mild form of Hypospadias needs surgical treatment. Although it is difficult to predict when, the chances of intense complications from this disorder are high.

According to worldwide research reports, around 15% of the affected children will have a downward curved penis – chordee. This condition affects the ability to have a normal erection in adulthood.

Also, if the urethral opening is positioned correctly, but is malformed or enlarged in size, this can hamper the normal flow of urine out from the body. Apart from this, if the abnormally developed foreskin is not corrected properly it can cause stressful conditions for the child as they grow up.

Is it safe to give anesthesia to the baby?

Hypospadias requires general anesthesia to prevent discomfort or pain to the patient. Expert anesthesiologists are employed in such cases to ensure complete safety and comfort to the baby for the duration of the surgery.

Which is the best surgical repair for my son?

There are several factors that decide which types of surgical approach are best in individual cases, such as extent of Hypospadias and the degree of curvature of the penis. The surgeon may even decide to use a specific surgical approach after beginning the procedure, depending on the findings of the initial incisions.

How do I care for my son’s wound after the surgery? How long will it take to heal?

Research has shown that wounds from Hypospadias repair surgery tend to heal on their own and do not require any special attention or care. Bandages may, or may not, be applied by the surgeon. In case bandages are applied, the surgeon will instruct you on changing the bandages and also give bathing instructions for the time.
In case a catheter is attached, it will drain the urine directly into the diaper, which is easy to change. Older children have the catheter connected to a bag which can be emptied as well. The catheter may be attached for around 5 days to a couple of weeks.

Healing of the wounds from the surgical repair begins immediately as the infant has a healthy immune system at that stage. Swelling and inflammation may be seen for a while following the surgery but this will disappear within the first few weeks.

Additional surgery will only be advised when severe complications arise, which is in rare circumstances.

What if my child has problems even after surgery for Hypospadias?

Corrective surgery is available to ensure that the problem is effectively treated. Complications may also require another surgery to correct them, in older children mostly. The corrective surgery has been found to be highly successful in treating the problem effectively.