Hypospadias
An irregular position of the urethral opening is a characteristic of hypospadias, a congenital abnormality of the penis.
Hypospadias is associated with:
1. Abnormal appearance of the glans penis (the head of the penis)
2. Abnormal foreskin formation
3. Downward bending of the penis (Chordee)
Hypospadias seems to be happening more frequently. It is estimated to occur in the US at a rate of 1 per 250–500 male births. When brothers or fathers have a history of hypopadias, the condition is more likely to occur in the family.
Why does hypopadias occur?
The cause of hypospadias is unknown in the great majority of cases. Sometimes it results from aberrant hormone activity. A sexual chromosome abnormality is even more uncommon.
Does hypopadias require treatment?
In most cases, mild hypopadias is a cosmetic issue. Children who suffer from moderate to severe hypopadias may experience difficulties in their daily lives. Boys may have trouble urinating and may not be able to do so while standing. Children who suffer from moderate to severe hypopadias may also have some fertility-related functional impairment. Your child’s ability to have sex as an adult may be impacted if he also has penile curvature.
Hypopadias cannot be cured by medication, and children will not outgrow it. For many years, hypopadias has been successfully treated surgically. Hypospadias should be treated by a specialist who performs numerous repairs, as is the case with most surgeries, particularly for young patients.
How can hypopadias be treated?
Urethroplasty – A new urethral tube is made to connect the urethral opening to the penis’ head. Foreskin or local skin is used to make this tube. An artificial erection will be created during surgery if your son is suspected of having penile bending in order to assess whether correction is required. The use of absorbable sutures is widespread. These don’t need to be taken out; they will dissolve. The surgeon frequently leaves a drippy stent (catheter) in the penis after creating a new urethral tube. While the new tube heals, this serves as a mould or cast. Your son won’t have to urinate thanks to this drippy stent that drains the bladder. Five to ten days following surgery, the drippy stent is typically removed in the office.
Is there anything else I should know about the surgery?
Surgery usually takes one to three hours, depending on how severe the hypopadias is.
· Options for anaesthesia will be discussed by the anaesthesiologist. For surgery, general anaesthesia is necessary for all children. Furthermore, we favour the use of a “caudal” anaesthetic. Though no tubes are left in place, this is comparable to an epidural anaesthetic.
· Your child will benefit from up to 12 hours of regional pain management both during and after the procedure. You will be informed by the anaesthesiologist about the very low risks associated with anaesthesia.
· Hospitalisation is rarely necessary for hypospadias repairs, which are typically performed as outpatient procedures. After spending one to two hours in the recovery room, your child will be sent home. For some families, staying at a local hotel for the first night is more convenient.
· For at least a week following surgery, we generally advise against a child returning to preschool or out-of-home creche. A parent or guardian may need to take a week off from work in order to accomplish this.
What potential side effects could the surgery cause?
· The most frequent consequence of surgery for hypopadias is the development of a “fistula.” An opening (hole) between the skin and the new urethral tube is called a fistula. Fistula formation has been reported to occur at a rate of 5–20%.
· The degree of your son’s hypopadias and whether or not he has had prior surgery determine the likelihood of a fistula developing. After surgery, if your child develops a fistula, it is typically repaired in a second outpatient operation.
· Complete disruption of the repair, haematoma (large blood clot) formation, proximal regression of the urethral opening, and urethral stricture (stenosis) formation are additional complications of hypopadias surgery.
After surgery, how will my son’s penis look?
The penis will be extremely swollen and discoloured right after the procedure. Over the coming weeks, this will be resolved. The degree of hypopadias, whether your son has had prior surgery, and the size and shape of his penis before surgery will all affect how his penis looks in the end. Notably, during puberty, your child’s penis will also undergo significant changes.