Hypospadias is a birth defect in boys in which the opening of the urethra is not located at the tip of the penis. In these cases the tube that carries urine from the bladder to outside of the body or the urethra does not end at the tip of the penis, rather ends on the underside of the penis. It can be mild or severe, in severe cases, the urethra opens in the middle of the penis or in some cases even behind the scrotum.
The treatment is aimed to facilitate the following.
- Urine should pass in a forward way
- The penis should be straight when erect
- The penis should look as normal as possible
The surgery for this condition is known as Urethroplasty. If chordee is present then this is corrected to straighten the penis. The success of the operation and the ‘normality’ that can be achieved depends on the severity of the hypospadias.
Why is Hypospadias Surgery needed?
Hypospadias Surgery is performed generally when boys are1 Year to 2 years old. If the hypospadias is mild, with the opening of the urethra just a little down from normal and with no bending of the penis, in that case, treatment may not be needed. However, in most cases an operation is required to correct the hypospadias. This can usually be done in one operation. However, if the hypospadias is more complicated, two operations may be necessary.
Preparation before the Surgery:
As mentioned earlier, the surgery isn’t a major one and does not require very specific pre-surgery preparations. The child’s health care provider may ask for the medical history of the child and suggest for a complete medical checkup before the surgery.
The procedure of the surgery:
The procedure is pretty simple and direct. The tissue extracted from the foreskin or some other part is used to make a tube. This tube is used to increase the length of the urethra. The extension is done so that the urethra opens at the tip of the penis. In many cases, during the surgery, an external tube called a Catheter is sewn or fastened to the head of the penis. This is done to keep it in place and help it retain a proper shape. It is usually removed after 1 – 2 weeks of the surgery. In many cases of Hypospadias, boys have a non-uniform or underdeveloped foreskin. This foreskin is circumcised at the end of the surgery. Most of the stitches used in this surgery are of a special type that dissolves on their own after the surgery and need not be removed manually.
After the surgery, the child’s penis is taped to his belly so that there is minimal movement to prevent any casualties. Often, the penis is protected by doing bulky dressing around the surgical area. A urinary catheter is placed so that the urine can flow out of the dressed area into the diaper. The child is encouraged to drink fluid so that he will urinate more, this prevents pressure from building up in the urethra. The child is given medicines to help relieve the pain. In most of the cases, the child is discharged within a day. A urinary catheter may be needed for 6-14 days after the surgery. The penis of your child may be seen swollen and bruised but it’s nothing to worry about. The whole healing process takes around 6-7 weeks.
What are the risks of Hypospadias repair?
All surgery carries a small risk of bleeding during or after the operation. For about one in ten boys, the original hole opens up again (fistula), and the patient passes urine through two holes. If this happens, the patient will need the operation again.
Dr Prashant Jain is a young and dynamic pediatric surgeon and pediatric urologist. He has been trained in premier institutes, King Edward Memorial Hospital (KEM), Mumbai and Kalawati Saran children’s hospital, New Delhi. He has been a meritorious student throughout his medical career and was gold medalist in his training in pediatric surgery and pediatric urology. He has special expertise and vast experience in pediatric urology and pediatric minimal invasive surgery. He was fortunate to get opportunity to work in Great Ormond Street, London.