Hypospadias
What is hypospadias?
Hypospadias is a birth defect found in boys in which the urinary tract opening is not at the tip of the penis. Bending of the penis on erection may be associated and is known as chordee. The cause of hypospadias is not yet known, but it results from lack of complete development of the urethra. The condition occurs once in approximately 350 male births,. When we see a boy with hypospadias there is a 20% chance of finding this in another family member such as father or a brother. While surgery is better early in your child’s life from a psychological point of view, it can also be performed at a later age when necessary. There are different degrees of hypospadias, some minor and others more severe. We name the types of hypospadias according to their anatomic location, but one must always determine whether or not there is associated chordee.
Why does hypospadias need to be repaired?
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). The ability to stand and urinate is important for boys. When the urethra opens before it reaches the glans a boy may be unable to stand and urinate with a direct stream.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. Early childhood is generally the best time for correction of hypospadias and/or chordee.
How are hypospadias and chordee repaired?
We recommend that the children have surgery to correct hypospadias at about six to nine months of age. Although we try and correct most children with one operation, about 10% will require a second surgical procedure to manage complications. If that is necessary, the second operation is delayed for one year. By performing the first operation early in life, both operations can be completed before the child is finished toilet training.
The operations performed to correct the hypospadias vary according to the degree of abnormality. The extra foreskin is sometimes needed to construct a new urethra. 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). We also leave a plastic dressing on the penis, which can be removed by the parent at home.
The prognosis is excellent for normal functioning and appearance of the penis following surgery. When they reach maturity, almost all patients will be able to have normal sexual relations and father children.
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