Failed Hypospadias is a condition that is quite common in young boys, occurring at the time of birth. Complications may occur if it is not treated. Even though Hypospadias has a very straightforward treatment. What could you do about it? Let’s know more about it.
What is Hypospadias?
Hypospadias is a birth defect that only occurs in Males. The Urethra, responsible for carrying urine outside of the body, develops abnormally instead of the usual location (tip of the penis). Most of the times, the opening of the urethra develops on the underside of the Male genital. However, there are many variations to it, and sometime it can also develop near the scrotum. The further it is from the usual position, the more severe the case could be.
Like most birth defects, causes of Hypospadias are not exactly known. Abnormal hormone production during pregnancy could alter the development of the reproductive system of the male fetus, which might sometimes result in Hypospadias. Physical damages have been shown to have no correlation with this condition.
Although there are no dangers to the people suffering from Hypospadias, there are still many complications that could arise in the patients. Some of them include:
- The irregular location of the urethra opening often leads to difficulty in urination. While it is manageable, it becomes very difficult for the young boys to learn doing it.
- More often than not, a person suffering from hypospadias has an abnormal penis, mostly with a curvature larger than usual. Not only does it pose problem with erection, it also might lead to low self-confidence of the individuals.
- Again, the abnormal shape of the penis and the location of the tip of urethra can affect ejaculation, sometimes making it impossible to achieve it. If not treated, it could lead to a problematic sex life and many psychological issues.
Failed Hypospadias Treatment
One has to understand that hypospadias is a condition for which surgery is the only treatment.
In most cases, a single surgery is enough to solve the issue. The urethra is adjusted so that it now points towards the tip of the penis and can work normally.
However, in the more complicated cases, multiple surgeries (in stages) may be required. Tissue grafts might be needed to reconstruct the urethra significantly.
The primary factor behind the success is the age of the individual. Children are known to have a success rate of about 95%, while it is lower in adults undergoing the same procedures.
The second major factor is the type of surgery undertaken. Repositioning of urethra is almost always successful, as it requires no additional procedure. However, creating a flap or grafts could be tricky and may often lead to complications.
Failed hypospadias surgery can be a major setback for the patients. The complications arising from the surgery may require multiple subsequent surgeries and hence, can impact the patient both psychologically and physically. Psychosexual analysis shows that Men with successful Hypospadias repair always have a better score than Men with failed hypospadias repair.
Steps to be taken before repair
The initial evaluation is very critical before carrying out the repair for hypospadias. The past failure has to be analyzed to understand the cause behind it. The most basic step, usually, is to view the complication that occurred with the failure. It could be a stricture, chordee, fistula or persistent hypospadias. Records of previous treatments are a great help in understanding the reason behind the complications, but often the failure occurs many years earlier and records are hard to obtain.
In any case, certain observations must be recorded. These include:
- Record of urine flow and any obstacles in it whatsoever
- Penile curvature
- Difficulty in intercourse and/or ejaculation
- Any infections in the urinary tract or stones in the urinary bladder
There are many ways failed Hypospadias could be repaired. Let’s take a look at them:
People suffering from urethral stricture after a failed Hypospadias operation could get it corrected surgically. A lot depends upon the length and location of the stricture itself. People having stricture that are small and/or located on the outside may require only a single surgery, while people with long and/or inside stricture may require staged urethroplasty along with grafting.
Excision and primary anastomosis
EPA is a very effective technique in dealing with stricture that are short and usually on the outside. While EPA is very successful in cases of urethroplasty, it must be used in case of Hypospadias with caution. Hypospadias is known to alter blood supply to the urethra, so it must be kept in mind using EPA. The doctor must ensure that the blood flow from the penile arteries must not be affected.
Preputial skin flap
While use of skin flap is common in most surgeries, it is rarely adopted in cases of Hypospadias repair. The reason is the lack of enough foreskin due to previous Hypospadias surgery, among other issues. For this reason, use of preputial skin flap has a high failure rate. However, if you have enough foreskin for creating skin flaps, then this technique could be used.
Single-stage buccal graft repair
In cases of long strictures, EPA is quite ineffective. Hence, buccal graft repair seems like the best option. Grafts are created from the buccal mucosa and used in the repair of strictures. However, even this method has only limited success, with strictures often recurring after some time. However, any method to repair long strictures in a single-stage surgery has high failure rate, and use of buccal grafts are the most effective among them.
For patients that have suffered multiple failed hypospadias, staged urethroplasty is the best chance. There are many considerations to be taken while undergoing staged urethroplasty. For instance, the choice of grafts has to be considered carefully before applying. Removal of urethral plate is another decision that must be taken wisely. In most of the cases, two stages are enough to repair any damage caused by a failed hypospadias operation. It must be noted that most men quit after the first stage itself, considering the second stage of urethroplasty closure as unnecessary.
Ventral penile curvature is another complication caused by a failed hypospadias surgery, though there are many ways to treat it. The most effective method is to induce an artificial erection. Things get complicated when both chordee and strictures are present in the patient. Removal of the urethral plate itself may seem like the best approach, but it rarely works. Instead, it would be better to perform staged surgeries while dealing with the two complications one-by-one.
Urethrocutaneous fistula is one of the most common complications caused after a failed hypospadias surgery. Like strictures, the treatment depends heavily on the size of the fistula. Smaller fistula could be repaired easily with additional catheter drainage. Longer fistula could be repaired by first excising the fistulous tract, then closing the urethra. Closure of fistula is the most prudent way of repairing it.
Hypospadias is a defect that can cause you a lot of inconvenience, or may not cause any discomfort at all but repairs are necessary after a failed hypospadias surgery, preferably as soon as possible.