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Understanding Hypospadias

Hypospadias, a congenital condition where the opening of the urethra instead of on the tip of the penis is located on the underside. Urine drains out from the bladder & exits the body through the urethra. Since it is a congenital condition it generally is a common phenomenon among infants Surgery which is recommended only for children who are aged 6 months to 2 years after birth helps restore the normal appearance of the penis.  

During the surgery, the penis is straightened & a new urethra along with a new opening at the tips of the penis is built. Although repairs for Hypospadias can require follow up surgery, sometimes faster than one can expect which is soon after the first one while other times it may be requires only after many years or even decades later.

Symptoms

Signs and symptoms of hypospadias may include:
 

  • Opening of the urethra located elsewhere other than the the tip of the penis
  • The penis is curved downwards also known as chordee
  • The penis has a hooded appearance since the foreskin covers only the top half of the penis.
  • Abnormal spraying during urination

Causes

Hypospadias is a congenital condition. During the development of the penis in a male fetus, there are certain hormones involved which help stimulate the process in the formation of the urethra and foreskin. When these hormones do not function as they are supposed to, it causes an abnormal development of the urethra. The exact cause of hypospadias is unknown, genetics is considered to be some of the factor, however environmental factors also have a role to play.

Risk factors

The exact cause of hypospadias is unknown, however the factors listed below may also play a role
 

  • Family Medical history.  Hypospadias is more common among infants whose family may have a history of hypospadias

  • Genetics. During the formation of male genitals in a male fetus the variation of certain genes may also affect the functioning of hormones which stimulate the formation process.

  • Maternal age over 35.  There are research which suggest that male infants born to women over 35 years of age may have an increased risk of hypospadias.

Diagnosis

A pediatrician can diagnose hypospadias in  a male child through physical examinations. The pediatrician will refer the guardian/ parents of the child to a surgeon whose expertise lies in pediatric genital and urinary conditions (pediatric urologist) for further evaluation & treatment.

Treatment

For patient’s whose diagnosis for Hypospadias is considered as a minor form do not require surgery, however, the major forms of hypospadias can be treated through different type of surgeries.While the surgery to correct the placement of the urethral opening is usually performed when the patient is aged 6 months to 2 years after birth. Other surgeries may include
 

  • Positioning of the urethra
  • Correcting the placement of the urethral opening
  • Reconstruction of the foreskin around the opening of the urethra. An infant who is diagnosed with hypospadias should not be circumcised since the foreskin may be required during surgery for repair.

 
Complications can include bleeding, infection, narrowing of the urethra (stricture), and curvature of the penis.

Surgery

Hypospadias can be corrected in a single surgery however some other forms of hypospadias will require more than one surgery. Tissue grafts from the inside of the mouth of the penis or the foreskin might be used in the surgery to proper position the urethra. The child is put under general anesthesia during the surgery. To prevent the child from urinating through the reconstructed urethra for a few days after surgery, a catheter which is a tiny plastic tube is stitched to the head of the penis which allows the flow if urine without coming in contact with the repaired urethra. This catheter is removed after  7 to 14 days.
 
To make the patient comfortable and reduce swelling, a dressing is wrapped around the shaft of the penis. Antibiotics along with medicine to stop bladder spasms will also be prescribed by the doctor.

Results of surgery

Hypospadias at Fortis Hospital, Bangalore has a high success rate where the penis looks completely normal after surgery, and the patient can urinate & reproduce normally. There is rarely a problem with healing or scarring, however, occasionally there may be urine leakage through the hole developed on the underside of the penis where the new urinary channel was created which may require follow up surgery.

Follow-up care

A couple of visits to the surgeon is required post surgery. After which a regular follow-up with the patient’s pediatric urologist is a must to check for recovery and any possible complications. Post surgery most of the males can urinate successfully while standing.

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Dr. Mohan Keshavamurthy

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