Hypospadias is a relatively common birth defect that occurs in approximately one out of every 350 male births. It is characterized by an abnormal positioning of the meatus, the opening from which urine passes. The degree of hypospadias depends on the location of the penis opening. The defect may occur anywhere along the underside of the penis down to the scrotum.
Accordingly, hypospadias can be classified into anterior hypospadias in which the opening is somewhere between the tip & the mid point of the penis & posterior hypospadias where it extends from the mid penile junction to the scrotum.
Chordee a downward curve of the penis, is usually, but not always, associated with hypospadias. As the urethral opening moves closer towards the scrotum the extent of penile curvature & other associated anomalies increase. These may necessitate additional procedures for correction.
Boys with chordee often must sit to void. The youngster who has to sit down to urinate on a toilet is at a painful social disadvantage. A straight penis is necessary for satisfactory sexual function. Although this may not seem to be an important matter in childhood, this is a crucial concern later in life. Males with hypospadias usually have normal testes and can father children.
Objectives
Hypospadias can be corrected surgically. Depending on the severity, the correction can be completed in one or more operations. The best age at which to have corrective surgery depends on the size of the penis and degree of the defect. Repair is usually advised at an early age, unless the patient is not referred until he is older.
At KSSH,we generally recommend repairing genital defects early, so patients can avoid embarrassment that can be associated with the condition.
Consultation
Each patient of hypospadias is unique & a careful examination can enable the surgeon to decide on the appropriate procedure needed. Some cases are amenable for a single stage correction while some may require more than one stage.
Procedure
The child's hospital stay may range from a few days or a week in the hospital. When the operation is completed, the extra skin is removed so the child will look circumcised. To protect the newly constructed urethra (neourethra) the urine is usually diverted with a stent (a silastic tube through the neourethra).
Surgical correction of hypospadias involves straightening of any chordee and then extension of the urinary tube (urethra) out to the tip of the penis (the glans). Corrective surgery usually results in a penis that looks normal and functions normally. Patients are able to stand to void, and sexual activity and fertility are satisfactory.
Although we try and correct most children with one operation, about 10% may require a second surgical procedure to manage complications.