What is hypospadias?

In boys, urine is passed via the urethra that normally ends at the tip of the penis. This enables them to pass urine in a standing position without any soiling of the legs. At times the urethral opens a little behind and on the undersurface of the penis, this condition is called hypospadias. The opening can be anywhere starting from behind the scrotum to the undersurface of the glans.
Hypospadias may be isolated or may be associated with other abnormalities of the genitals like a deficient foreskin, bending of the shaft of the penis and high riding scrotum.

What causes hypospadias?

Hypospadias is a congenital defect. That means that it is present from birth and is usually not associated with a specific cause. However, when present with other features like a very small penis, absent testis in the scrotum or bifid scrotum can be due to a deficiency of male hormones during intrauterine development. Such children need further blood tests and scans to diagnose the hormonal factors if any.

Why should Hypospadias be treated?

Hypospadias is associated with various physiological and psychosocial disadvantages to the child. First is that due to the fact that the urinary meatus is not at the tip of the penis, these children, when they grow, might not be able to deposit semen in the right place during coitus. This can lead to infertility. At times the urinary opening is very small and can cause increased pressure inside the urinary tract. This leads to what is known as back pressure changes and ultimately might contribute to renal damage.

When there is hypospadias the child is not able to urinate in a straight line especially in standing position. More often than not the child's clothes and shoes get soiled forcing him to urinate in a squatting children. This can lead to social embarrassment and ridicule in school going children. These children tend to have body image disorders and low confidence levels when interacting with peers.

Studies have shown that correction of hypospadias at the appropriate time tends to avoid and reverse most of the physiological and psycho-social problems associated with it.

When should we meet a pediatric surgeon for hypospadias?

Hypospadias if diagnosed at birth are referred to the pediatric surgeon soon after. This enables the surgeon to properly evaluate the child and take any measures to prevent back pressure changes or evaluate the boy for hypoandrogenic conditions if needed.

In case the condition is suspected or seen in an older child, a pediatric surgeon is to be consulted immediately so that the child can be evaluated and the specific plan for correction can be formulated.

How is hypospadias corrected?

Hypospadias correction involves constructing a tube that connects with the abnormal meatus and opens at the tip of the penis. Usually the tube is made out of the skin that is present on the phallus.

When the abnormal meatus is very near the tip and there is no other significant associated deformity then the correction can be done as a single stage. At times how-ever the opening is very back and /or there are significant other deformities of the genitals. In such cases the corrections need to be done in multiple stages. Skin from inside the mouth or other areas of the body might also be needed to make the tube. This is called as staged repair

In short there are many different techniques of correction of hypospadias and the plan for each child needs to be individualised based on the extent of correction required and the child in general.

What is the best age for hypospadias correction?

It is recommended that the defect is corrected before the child attains school age. This is done so that the psychological impact may be minimized. Each child needs to be evaluated individually and the specific plan needs to be made. Therefore most pediatric surgeons prefer to see the child at around 1 year of age. Those children that are expected to receive single stage repair may be operated slightly later. But those children that require staged repair need to undergo the first stage earlier.

The exact age of the surgery that is best suited for the child is decided by the surgical team based on the individual anatomy of the child.

What to expect after hypospadias surgery?

After the correction of hypospadias it is standard practice to put a thin pipe into the newly constructed tube so that the healing is better. This pipe is meant to drain the urine so that the operated site is kept as dry as possible . a dressing is applied on the operated area and the child is put on diapers.

The child can move around and go about his daily activities. However spending more time in bed is encouraged in these children. The dressing is changed once every 3-4 days and/ or when the dressing gets soaked.

The pipe is removed in 7-10 days after which the child is expected to void normally from the newly constructed meatus. The surgeon might suggest some simple measures to keep the opening wide for the first 3-6 months after the surgery.

What are the common complications after hypospadias surgery?

Hypospadias is a low risk surgery and is not associated with major complications. Some children might experience increased soakage of the dressing for which a compressive dressing is applied. In others there might be improper healing of the stitches leading tiny holes forming in the tube. Rarely the entire tube might break down.
Minor complications are treated conservatively and do well. Those with more severe break down or large fistulae may require another surgery to deal with them. Inspite of setbacks almost all the children of hypospadias become normal by the time they are ready to start school.

What is the long term outcome of hypospadias?

Children with isolated hypospadias do extremely well in the long term. They can void as any normal boy and are expected to have a normal looking penis. These boys, when they grow up, are expected to have a normal sexual life .
In those children where the hypospadias is a part of other hypo androgenic condition the outcomes and prognosis depends on the underlying cause.

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