How is hypospadias treated?
Written by:Hypospadias is a common congenital condition that occurs in 1 in 200 newborn babies.
Here, Professor Imran Mushtaq, renowned Consultant Paediatric Urologist based in London, provides an expert insight into hypospadias, including how it is treated.
What is hypospadias, and what causes it?
Hypospadias is a condition in which the opening of the urethra, which is the tube that carries urine from the bladder to the outside of the body, is found on the underside of the penis instead of at the tip. This is a condition that is present at birth.
The exact cause of hypospadias is unknown, but it is believed to occur during fetal development if the tissues that form the urethra don’t fully close. Some studies suggest that there may be genetic factors involved, as hypospadias can sometimes run in families. Hormonal factors, such as disruptions in testosterone levels during pregnancy, may also contribute.
In some cases, hypospadias can also be associated with undescended testicles, and may then require further hormonal testing to identify a potential underlying cause. These tests may require the help of a hormone specialist or what we call an endocrinologist.
In rare cases, hypospadias may be so severe that it may not be possible to determine the true sex of the baby, which is what we term a DSD (disorder of sex development).
How is hypospadias clinically diagnosed?
Hypospadias is diagnosed via a physical examination by a paediatric urologist. The specialist may also inquire about the baby’s medical history, including any family history of hypospadias or related urological conditions. The paediatric urologist will examine the genitalia in detail to determine the severity of hypospadias.
The commonest form of hypospadias is where the urethral opening is just below the head of the penis, and this is termed a coronal or distal hypospadias. This type can usually be corrected in a one-stage operation.
Sometimes, the urethral opening is much further back on the shaft of the penis, close to the junction with the scrotum, and we call this a penoscrotal or proximal hypospadias. This type of hypospadias is often associated with significant curvature of the penis, which is referred to as chordee. A penoscrotal type of hypospadias usually requires a two-stage operation to get the best possible cosmetic and functional result.
Is treatment always needed? How is hypospadias repair performed?
Surgery is generally required to correct hypospadias by repositioning the urethral opening to the tip of the penis. The operation is performed by a paediatric urologist, usually when the child is between 6 to 18 months of age.
In very mild types of hypospadias, where the urethral opening is close to where it should be and there is just a minor cosmetic issue, some parents may choose to have no surgery at all. In such cases, the child will still be able to function normally in their adult life.
Hypospadias repair is always performed under general anaesthetic. During the surgery, the specialist will aim to:
- straighten the shaft of the penis, if it is curved
- move the urethral opening to the tip of the penis, and close over the hole that was previously there
- reconstruct part, or all, of the urethra
- remove the foreskin (circumcision)
In some cases, where the urethral opening is close to the base of the penis and the existing urethra is too short, the specialist will use the foreskin to make a new urethra to the tip of the penis. In the first operation, the penis will be straightened and the skin will be grafted onto the underside of the penis. After six months, in the second operation, the surgeon will then use that skin to reconstruct the urethra.
After each surgery, the child will be monitored by the surgical team in a recovery area. The child will have a tube to drain the urine from the bladder into the nappy, and will have a secure dressing or bandage on the penis. This tube and bandage will stay for 1 week.
The child will stay in hospital for 1 night and then can recover at home. The child’s parents will be given instructions on how to look after the bandage and the urine tube, which usually drains into the nappy. The tube and bandage are removed after 1 week by a team of specialist nurses.
Follow-up appointments will then be required to monitor healing, address any concerns, and ensure adequate progress.
What are the potential risks and complications associated?
Hypospadias repair is generally considered safe and effective.
However, like any surgery, it carries some risks and potential complications.
These may include:
- bleeding
- infection at the surgical site
- urethral fistula (hole), leading to urine leakage
- urethral stricture (narrowing of the urethra)
- meatal stenosis (narrowing of the urethral opening)
- cosmetic issues
- anaesthesia risks
Will my child experience any long-term effects from hypospadias?
Successful hypospadias repair improves the appearance of the penis and restores normal urinary function. In the future, the operation will also enable normal ejaculation and sexual function.
In most cases, children will lead normal, healthy lives without significant long-term effects related to hypospadias. Regular monitoring by the paediatric urologist, as well as adherence to the postoperative care instructions provided, will allow for the early detection and management of any potential complications that could arise in the long-term.
Ensuring that the child receives the correct type of surgery for their type or degree of hypospadias is paramount in ensuring a successful and sustainable long-term outcome.
Professor Imran Mushtaq is a distinguished Consultant Paediatric Urologist with over 20 years of experience in hypospadias surgery, performing 50 to 100 hypospadias surgeries every year.
If you have specific concerns about your child’s hypospadias, don’t hesitate to book an appointment with Professor Mushtaq via his Top Doctors profile today.
