Hypospadias

WHAT IS HYPOSPADIAS?

Hypospadias is a birth defect in baby boy in which the penis neither works well nor looks normal. It is the defect of the Urethra in the male where the urinary opening (Meatus) is not at the usual location on the head of the penis instead that is on the underside of the penis or below the penis associated with curvature (in few cases) and disfigured skin.

 

HOW IT IS DIAGNOSED?

It is diagnosed on the basis of a physical examination done by a urologist. It is one of the most common birth abnormality in boys, affecting approximately 1 of every 250 new born boys.

 

CAUSES OF HYPOSPADIAS

The exact cause of hypospadias is unknown.  There are many factors believed to be involved in its development. Genetics, the environment and hormones may be factors that influence the development of this structural difference. Sometimes hypospadias is genetic.

PRESENTATION OF HYPOSPADIAS MAY INCLUDE:

  • Opening of the urethra at a location other than the tip of the penis
  • Abnormal splaying during urination
  • Downward curve of the penis (chordee) A condition called chordee is often seen with Hypospadias. Chordee is a downward curve of the penis. The foreskin is often not completely formed on its underside. This result in a “dorsal hood” that leaves the tip of the penis exposed.
  • Hooded appearance of the penis as only the top half of the penis is covered by foreskin

 

 

THE TYPES OF HYPOSPADIAS INCLUDE:

  • Distal or Glanular:  most common form when opening is found near the head of the penis
  • Midshaft:  when opening is found in the middle to the lower shaft of the penis
  • Penoscrotal:  when  opening is found where the penis and scrotum join
  • Perineal: when opening is behind the scrotal sac. These are the most severe forms of hypospadias and are less frequently found.

 

 

 

FAILED HYPOSPADIAS

There are more chances of failure if males with Hypospadias are operated by a routine Urologist. Adults / Children with complications following childhood hypospadias repair can still be re-operated with good success rate if are operated by a reconstructive urologist who has been performing routinely.

 

ADULT HYPOSPADIAS

Adult hypospadias are those Males diagnosed with Hypospadias but has not got it corrected at childhood; they live with hypospadias all their life. Such Men suffer needlessly with a regret that they went through their life ignorant to options.  This is absolutely treatable disorder. They can have a normal appearing and functioning penis. They can pee normally and not spray all over the place. They can have pain free sex.

TREATMENT

The goal of any type of hypospadias surgery is to make a normal, straight penis with a urinary channel that ends at or near the tip. The operation mostly involves 4 steps:

  • straightening the shaft
  • making the urinary channel
  • positioning the meatus in the head of the penis
  • circumcising or reconstructing the foreskin

Hypospadias repair is often done in a 90-minute (for distal) to 3-hour (for proximal) same-day surgery. In some cases the repair is done in stages. These are often proximal cases with severe chordee. The Reconstructive Urologist often wants to straighten the penis before making the urinary channel.

Hypospadias can be fixed in children of any age and even in adults.

A successful repair should last a lifetime. It will also be able to adjust as the penis grows at puberty.

“Surgical correction can be undertaken in early childhood or in later life by a reconstructive urologist”.

 

 

HYPOSPADIAS IF UNTREATED influences a man’s psycho-social status. Affected man often feels like he has got this horrible secret in his pants and if others will find out, they would make fun of him.  Hypospadias leads to shame, aloneness and depression that a guy can feel when he is growing up. One of the reasons for feeling so different is because he needs to sit down to pee unlike other Males.

Parents usually ask the Urologist that their child urinates comfortably and has bowel movements just fine. So why are we having the surgery done if it doesn’t hurt him and he urinates just fine? Simple answer to these parents is Surgery is essential because Hypospadias can cause following problems as he gets older:

1. Irregular urine stream .He would have to pee sitting down his whole life.

2. His penis would look different than other boys.

3. It could potentially create fertility issues. The opening of the penis is not close to the cervix as a result of which the sperm is not in the right place to cause pregnancy.

4. If the penis has chordee (downward curvature of the penis) it becomes very painful, difficult or even impossible to have intercourse as an adult.

POST-OPERATIVE COMPLICATIONS

The complication rate in boys with distal hypospadias repair is less than 1 in 10. Problems happen more often after a proximal correction.

The most common problem after surgery is a hole (“fistula”) forming in another place on the penis. This is from a new path forming from the urethra to the skin. Scars can also form in the channel or the urethral opening. These scars can interfere with passing urine. If your child complains of urine leaking from a second hole or a slow urinary stream after hypospadias repair, he should see his pediatric urologist.

Most complications appear within the first few months after surgery. But fistulas or blocks might not be found for many years. Most problems are easily fixed with surgery after the tissues have healed from the first operation (often at least 6 months).

 

 WHAT IS THE RECOVERY TIME AFTER THE PROCEDURE?

Recovery time is bit longer in patients following Re-do surgery for failed hypospadias repair with respect to the Hypospadias surgery done initially. The patient after Re-do surgery can start peeing normally after 2-3 weeks. It may take 3 months for the penile skin to be healed fully. Urinary catheter is kept for 10-20 days post surgery.

 

 WILL I HAVE NORMAL FEELINGS AFTER HYPOSPADIAS SURGERY?

Yes definitely the patient can have a normal penis provided the surgery is done by a Urologist specialized in Hypospadias Repair. You need to follow the instructions given by the surgeon strictly. Do visit for a follow up after the procedure.

 

HOW LONG DOES THE HYPOSPADIAS SURGERY TAKE TO COMPLETE?

Usually it takes 3-4 hours to operate such cases but it differs from case to case depending upon the complexity of the disease. In few cases need multiple stages 6-8 months apart.

WHAT IS THE SUCCESS RATE OF HYPOSPADIAS REPAIR SURGERY?

Modern anaesthetic techniques, fine instrumentation, sutures, dressing materials, and antibiotics have improved clinical outcomes and have, in most cases, allowed surgical treatment with a single-stage repair within the first year of life on an outpatient basis.

Success Rate at Centre of Urethra and Penile Surgery is 95%.

 

WHY TO CHOOSE CENTRE OF URETHRA AND PENILE SURGERY?

  • At our centre for Urethra and Penile surgery the success rate is high as we use latest techniques to operate. We encourage such patients to get themselves reviewed atleast once in a year.
  • Gautam Banga has successfully operated more than 800 Hypospadias cases in his one decade of experience.
  • High success rate in primary cases
  • Achieved success in failed cases of Hypospadias
  • Gautam Banga is invited by his fellow Urologists as a core-specialty expert in Genito-Urinary reconstruction in various parts of Delhi-NCR.

To know more please contact :

Dr. Gautam Banga

MBBS,MS,M.Ch (Urology)
Urologist, Andrologist and Genito -Urinary Reconstructive Surgeon
Contact no. : 91- 9886624303 | +91-9999062316 | 011-41041131
Email:- info@urethraandpenilesurgery.com