Hypospadias is a common occurrence in the male infant which can be corrected through a simple surgery. Thanks to our team of pediatric urologists, and hospital care, we will assist you in getting the right treatment just meant for your boy.
Hypospadias is a birth defect in the male child in which the opening of the urethra is abnormally positioned on the underside of the penis instead of being at the tip. This abnormal formation could happen around 8 – 14 weeks of pregnancy. The urethra is a tube that carries urine from the bladder and exits out from the body.
The degree of Hypospadias could range from mild to severe. If it is mild, it may not be necessary to operate it, but some parents do for cosmetic reasons. If an abnormal Hypospadias is left untreated, it could affect urinating, sexual performance and, fertility later in life.
Types of Hypospadias
The abnormal opening can be anywhere under the penis to the scrotum.
- Distal or glandular: This is most common. The opening is found near the head of the penis.
- Midshaft: When the opening is in the middle to the lower part of the penis.
- Penoscrotal: When the opening where the penis and scrotum join.
- Perineal: This is rare but severe, the opening can be found behind the scrotal sac.
Although the cause of Hypospadias is still unclear, certain factors may increase the risk:
- During pregnancy, due to treatment with hormones like progesterone
- Failure to produce enough testosterone
- Failure of the body to respond to testosterone
- Family history
- Maternal age over 35
In newborns and infants, symptoms might be mild, but some abnormal case can have:
- Spraying urine
- Difficulty in directing the urine stream
- Having erections that are not straight
- Impossible to stand while urinating
- Downward curve of the penis (Chordee)
- Likeliness to have undescended testicles
Diagnosis and tests
- Physical examination of the new-born or infant
- Excretory urogram
Types of Surgery
- Repositioning of the urethra
- Correcting the urethral position in the head of the penis
- Reconstructing the skin around the urethral opening
- Surgical repair of the skin if needed
Goals of surgery
- Urine to be passed in a forward manner
- For a penis to be straight during erection
- To have a normal looking penis
- Physical examination of the male child
- Surgery will be performed when the child is around 6 – 24 months old or can be done later
- Male infants should not be circumcised as the tissue will be needed for surgical repair
- Small doses of male hormone may be given to increase the size of the penis and improve blood circulation in the area
- The child may need to fast, instruction will be given by your doctor
- Surgery is done either as an outpatient basis or with an overnight stay
- If the condition is severe, multiple stages of surgical repair may be done
- General anaesthesia is administered
- The surgery is performed for an hour or two
- The surgeon takes a foreskin to create a tube that increases the length of the urethra
- The surgeon moves the opening of the urethra to the end of the penis
- If there is a Chordee, the surgeon will straighten the shaft of the penis
- Circumcising the foreskin of the penis that is abnormal may also be done
- A catheter is stitched at the head of the penis to allow urine flow without being in contact with the surgical repair
- A dressing is done around the shaft of the penis to reduce swelling and discomfort
- The child may be sore after the operation, but this is normal
- Antibiotics and other medicines will be given to stop bladder spasms
- The surgeon may prefer the child to not urinate through the repaired urethra for a few days
- The catheter will be removed after 7 to 14 days
- If dissolvable stitches are not used, then they will be removed after a few days
- Follow-up review will be scheduled.
Risks and complications
Although Hypospadias is very successful, most complications are found after six months of surgery while some are not found for many years. Complications below can be corrected with another operation:
- Occurrence of a hole or fistula
- Leakage through the hole
- Wound dehiscence: The incision may open or split apart. This may need another operation
- Bladder spasms due to presence of a catheter
- Recurrent chordee: Another operation may be required to remove excess fibrous tissue
- Urethral stenosis: Treated by dilating the meatus with urethral probes
Factors affecting the cost of Hypospadias
Certain factors should be considered while getting the budget estimate:
- Severity of the condition
- Type of treatment and surgery
- Choice of hospital
- Surgeon’s fee
- Cost for blood tests and diagnostic tests
- Medicinal costs
- Duration of stay
- Cost of post-surgery care