Hypospadias
What is hypospadias?
Hypospadias is a birth defect of the penis that occurs in about 3 of 1000 male births. Most of the time, the cause is not known, although the problem can run in families. It can be recognized easily after birth because the urinary opening is on the underside rather than at the tip of the penis. Usually the foreskin is fully formed on only one side and the penis is bent down towards the scrotum. Most often circumcision will not be performed when hypospadias is present, since the foreskin may be needed for the surgery to elongate the urinary channel. Usually a boy with hypospadias has no other birth defects. However, if the testicles are not descended into the scrotum or the penis is very small, your child may need to undergo further testing.
What problems does hypospadias cause?
When left untreated severe forms of hypospadias will prevent a man from having sex or fathering children. This occurs because the penis is bent significantly on erection. Also, the abnormal location of the urethral opening may make it difficult to pass urine in a straight stream that can be easily aimed. The unusual appearance of the penis may lead to embarrassment or even psycological or sexual problems.
How is hypospadias corrected?
A surgical procedure is required to correct hypospadias. The goals of the surgery are:
- to straighten the penis
- to move the urethral opening to the tip of the penis
- to remove the excess foreskin. Your surgeon will make every effort to make the penis look completely normal.
The procedure can take up to several hours and requires general anesthesia. In some, more than one operation may be needed to fully correct the problem. In some cases, we will recommend that your child be given male hormone (testosterone) prior to surgery to help the foreskin and penis grow and make the surgery easier. Most of the time we do the surgery all at one time and allow your child to go home the same day.
When is surgery performed?
We usually wait until your child is 6-12 months old to perform the surgery because at this time the anesthetic risks are low and psychological stress of surgery for the child is minimal.
How do I care for my child after surgery?
Your child will be sent home with a tube in the penis which drains urine into the diaper. We recommend that you use disposable diapers changed a little more frequently than usual. The penis will be wrapped with a sticky clear dressing and usually comes off by itself. We remove the catheter 3-7 days after surgery. If the dressing rolls down towards the bottom of the penis, (close to the scrotum) you should contact us because it should be removed. Give sponge baths only until the catheter is removed. Your child may be given an antibiotic and a bladder relaxing medicine while the catheter is still in. Tylenol or tylenol with codeine can be given for pain. Avoid active play or straddle toys (such as a bicycle) for 4 weeks. All the stitches (except the one holding the catheter) will dissolve.
When should I call the doctor?
After surgery, you should call us if you see persistent bleeding that does not stop with light pressure, if the catheter stops draining, if your son has pain that cannot be controlled or if he has a high fever that persists. You will need to make an appointment to see your urology doctor on the day that he/she wants to remove the catheter and dressing. You can make this appointment on the day of surgery or call us after you get home.
What are the possible complications of surgery?
The most common complication is a fistula, or a leak of urine along the shaft of the penis. This may close on its own in the first six months after surgery, or may need to be repaired. Other complications include scarring of the new urethra at the tip or elsewhere (stenosis or stricture), bleeding, infection, or breakdown of the closure. Rarely, the new urethra may overdistend with time. Your child will be checked for problems soon after the catheter is removed. You should call us if you notice problems at any time. Even if he appears to be doing well, it is important that you bring him back so that we can check his urinary stream after he is toilet trained.