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I was told my new baby may have a hypospadias. Is it serious?
Hypospadias is an anomaly of the penis comprising excess curvature (chordee), a hooded appearance of the foreskin, deficient foreskin on the bottom side of the penis and an abnormal urinary tract opening. It is one of the most common congenital anomaly, affecting up to 1 in 100 boys (1). It causes spraying of urine, wets the pants when the child is standing to pee, and curved erection (chordee) which can be painful. Thankfully, hypospadias is not life threatening, and not commonly associated with other anomalies.
What other anomalies can hypospadias be associated with?
A proximal hypospadias can be associated with undescended or absent testis, disorder of sex development, abnormalities of the scrotum for example, bifid scrotum or penoscrotal transposition. These should be diagnosed and managed by a paediatric surgeon or pediatric urologist.
Can medicine cure hypospadias?
No, it is corrected only with surgery to ensure normal urine and sexual function. Testosterone pre operatively has not been shown to improve outcomes, and I do not recommend my patients have them (2). If they do, there is the risk of masculinization, agitation, increased bleeding during the surgery and worse scarring post op.
When is the best time to correct hypospadias?
There is no consensus on the best age for hypospadias repair. The best time is before the child becomes aware of himself, to minimize the psychosocial effect of the condition. Although it was classically proposed to be performed from 6 months to 18 months old, repairs done later than 18 months old have been shown not to affect the functional outcome or appearance of the repair (3).
What happens during the surgery?
Hypospadias repair is performed under general anaesthesia. The aims are to repair the excess curvature (chordee), bring the urinary opening to the tip of the penis and repair any rotation anomaly. When there is a urethra reconstruction, a urinary catheter is inserted as part of the surgery. A dressing is placed over the penis and needs to be kept on. When it is a proximal (penoscrotal or scrotal) hypospadias, I prefer to do a single stage repair. However when the available skin for tubularization of the urethroplasty is not enough, the skin is stitched to the ventral surface of the penis and left for 6 months. Six months later, the 2nd stage repair is performed by creating a tube out of the ventral foreskin. The risk of complications e.g. dehiscence, stricture and fistula are higher with a proximal hypospadias.
How is the follow up care post hypospadias repair?
It is important to prevent your child from pulling off the catheter or dressings. Your child will be given painkillers. Minimal bleeding is expected. Please check for clear urine in the catheter and soft stools, because these help to relieve the pain. The dressings will be removed on post op day 5 and the catheter on post op day 10. I advise my patients to excuse physical exercise for 2 weeks.
In a 2 staged repair, the 2nd stage is performed 6 months later. This allows the skin to heal well and mature for the reconstruction of the new urethra. Post op care is similar to a single stage repair and is detailed above.
1. van der Horst HJR, de Wall LL. Hypospadias, all there is to know. Eur J Pediatr. 2017 Apr;176(4):435–41.
2. Chua ME, Gnech M, Ming JM, et al. Preoperative hormonal stimulation effect on hypospadias repair complications: Meta-analysis of observational versus randomized controlled studies. J Pediatr Urol. 2017 Oct;13(5):470–80.
3. Bush NC, Holzer M, Zhang S, et al. Age does not impact risk for urethroplasty complications after tubularized incised plate repair of hypospadias in prepubertal boys. J Pediatr Urol. 2013 Jun;9(3):252–6.
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