What is Hypospadias?
Hypo = below
Spadon = a fissure or a ‘hole’
Hypospadias is where the opening for passing urine, called the ‘urethral meatus’, is below the head of the penis (called the ‘glans). This ‘hypospadiac’ opening can be anywhere from the glans to the base of the penis or even in the scrotum.
Hypospadias may be associated with other features:
· Bent penis: This is called ‘chordee’ – some boys with hypospadias have this.
· Hooded foreskin: The foreskin is only partially formed around the front of the penis.
· Rotated penis: Sometimes the penis is also abnormally twisted.
Classification:
Hypospadias is classified into ‘distal’ where the meatus is near the tip of the penis, ‘proximal’ where the meatus is near the base of the penis or scrotum, and ‘middle’ in between.
How common is hypospadias?
1:300 boys are born with hypospadias.
What is the cause?
Most cases occur sporadically, for no known reason. Recent evidence genetic and hormonal factors are involved in at least some cases.
What is the treatment?
Surgical correction is usually advised for the following reasons:
- Allow a straight urinary stream whilst standing.
- Allow a straight erection.
- Cosmetic reasons.
When should the operation be done?
Surgery can be performed anytime. It is ideal, if possible, to perform hypospadias surgery between 6 and 18 months of age.
How is the operation performed?
Under a general anaesthetic (fully asleep) in the operating room.
The 3 aims of the operation are to:
- Reposition the meatus (hole) onto the head of the penis.
- Check that the penis is straight and if not, straighten it
- Correct the hooded foreskin, usually by circumcision.
More than one operation may be required to achieve these goals.
The foreskin is used for the repair. It is therefore very important that your child does not undergo circumcision prior to hypospadias repair.
What to expect after the operation
- Swelling and bruising:
- This is very common. Often the swelling and bruising is very marked. If you are concerned, please call your surgeon.
- Pain:
- Your surgeon or anaesthetist will generally use local anaesthetic to reduce pain after the operation. This wears off after a few hours. At home, give paracetamol for pain relief.
- Appearance:
- The penis will appear circumcised unless a foreskin preserving procedure has been performed. Swelling and irregular areas of skin may be present.
- Stitches:
- The stitches are dissolvable.
What are some of the possible complications?
- Infection.
- Bleeding / bruising.
- Fistula (an abnormal side hole or ‘leak’).
- Breakdown of the repair.
- Meatal stenosis (where the new opening is too narrow).
- Meatal retraction (where the new opening retracts back down the penis somewhat).
- Stricture (narrowing) of the new urethra.
- Recurrent chordee or bend.
- Abnormal appearance.
Overall, the complication rate is higher the more proximal, or the further down the penis the meatus is. Fistulas occur in approximately 5-10% of distal, 20% of middle and 30% of proximal hypospadias.
With a foreskin preserving procedure, there is a
