Hypospadias Repair

We feel that parents should be involved in decision making at every stage. This is an overview of the pathophysiology of hypospadias and possible treatment options.
What is hypospadias?

Hypospadias is abnormal growth and development of the tissues on the ventral (under-surface) aspect of the penis. This may cause abnormal opening of the urine tube anywhere from the scrotum up to the penile tip, curvature of the penis and problems while passing urine in standing position.
Why does it happen?

The exact cause is not known but many factors including genetic factors may contribute.

When the penis is being formed the urine tube initially is open sulcus that later on closes to form a tube. This closure begins from the base of the penis and progresses to its normal location at the tip. If this process gets interrupted in-between then the opening may remain at an abnormal place.
What are the types of hypospadias?

Hypospadias can be of various types depending on the location of this opening of urine tube (urethra). It can be glanular (on glans), coronal (at the sulcus between the glans and the body of penis), on the penile shaft (this type is divided in to 2 subgroups proximal and distal shaft) and peno-scrotal at the junction of penis and scrotum. Very rarely the scrotal halves remain separate and it opens directly on the perineum (perineal)
Can there be other associated problems?

This condition is rarely associated with malformations of kidney and other parts of genitourinary system
What is correct age for surgery?

Surgery can be performed at any age after 6 months of age. When it is corrected early, child will have no memory of it. Even older boys usually do not have problems with the surgery. After complete healing there are little noticeable marks of the operation. A successful repair lasts lifetime; including periods of rapid penile growth.
What operation will correct the problem?

Hypospadias repair transfers the location of urine tube from more proximal one (abnormal) to its normal position at the tip. It is done under general anaesthesia, meaning that he will be sound asleep during the surgery. This surgery takes between 1 to 2 hours.
What Is Hypospadias Repair?

Penis acts as a conduit for the urine and sperms while they leave the body. Both these are expelled out through a tube called urethra (referred as urine tube elsewhere for understanding) which opens at the end of the penis. Most of the children will also have ventral bending of the penis (when erect). The hypospadias repair surgery will reposition the opening and correct the bending to give the penis a more normal appearance.

The surgery will deal with following things

Creating the urine tube that has failed to form
Relocating its opening to the tip of the penis
Straightening the penile shaft if curved
Removal/ reshaping the abnormal foreskin
In complicated cases more extensive or stages repair may be necessary.

Which anaesthesia will be used?

This operation is usually performed under general anaesthesia. General anaesthesia will make the child go into deep sleep. General anaesthesia makes the surgery easier and safer as the child will not feel any pain or have any memory of it.

Caudal block is given along with general anaesthesia. It has two advantages; it blocks pain in the low back and trunk during and following the surgery and will reduce the requirements of GA medicines.
After the operation

Child can start eating and drinking a little at a time within 2 hours of surgery and can resume normal eating and drinking as early as he feels.

There will be a tube coming out from the tip of the penis connected to urine bag. Staff will teach you regarding empting the bag. Child carries the bag to home and it will be removed after a week or 10 days.

If a dressing was used, you will be told how to care for it. An ointment may be recommended or prescribed for you to use with the dressing.

If you notice a fever higher than 101.4˚F, bleeding or foul smelling drainage from the area around the repair, call the hospital.
Special needs

If your child has any special needs or health issues you feel the doctor needs to know about, please call your doctor’s office before the surgery and ask to speak with a nurse. It is important to notify us in advance about any special needs your child might have.

Article by
Sparsh Hospirals,
Bangalore