Hypospadias is a birth defect affecting boys. Understanding hypospadias is crucial for parents of affected infants and children as it affects urine flow and later in life their sexual life.
The symptom of this condition in children results in urine not flowing from the tip of the penis. Meaning, the flow of urine is from different parts of a penis, particularly from the base of the penile shaft. The urine exits the body through a tube called the urethra, which also transports the semen.
This post will cover the diagnosis, necessary procedures, and much more about hypospadias repair surgery.
Hypospadias Repair Meaning:
Hypospadias repair is a surgical procedure to correct the placement of the urethral opening. The surgery aims to restore normal appearance and function, allowing for proper urination and, in the future, sexual function.
Is Hypospadias Repair Surgery Necessary?
Hypospadias repair surgery is recommended to ensure normal urinary function, a near normal appearance and to avoid later complications. Early surgery can prevent issues such as urinary tract infections, abnormal urine stream, and potential fertility problems in adulthood.
If it is left untreated, it can lead to complications like urinary difficulties as mentioned above, and psychological distress.
Hypospadias Repair Age in Infants & Adults:
Most hypospadias repairs are performed between 6 months to 2 years old, sometimes 3 years old. However, adults can also undergo the surgery, though the approach and considerations may differ. Early intervention often results in better outcomes.
Diagnosis:
Children’s doctors aka Paediatricians typically identify hypospadias during a physical medical examination shortly after birth. Diagnostic tests might include imaging studies to determine the extent of the hypospadias and plan the corrective surgery by a Paediatric Urologist.
Hypospadias Repair Surgical Treatment
Hypospadias repair is generally considered a major surgery due to its complex nature and the need for general anaesthesia. It can correct different types of hypospadias.
This surgery involves creating a new urethral opening at the tip of the penis, correcting any penile curvature (chordee), and its appearance. Various techniques can be used depending on the severity of the condition, including the Tubularized Incised Plate (TIP) repair and the Onlay Island Flap repair, etc.
Recovery time varies, but careful postoperative care is essential for optimal healing.
Hypospadias Repair Surgical Procedure Steps and Stages
A Paediatric Urologist assesses the child and accordingly explains the plan for the surgery to the parent of the child.
There are 3 main steps for this surgical procedure - reconstructing the urethra, repositioning the urethral opening, and ensuring proper urine flow, after correcting any curvature, if any.
Before, During and After Surgery:
Your child is made ready for anaesthesia and surgery. Also, it is advised for your child (patient) not to eat or drink for three or four hours before the operation.
Procedure Stages
The procedure can be done in one or two stages, depending on the severity of the condition.
- One-Stage Repair:
One-stage repair surgery is suitable for less severe cases where the urethral opening is closer to the tip of the penis. The surgeon creates a new urethral channel using tissue from the foreskin or the surrounding area and moves the opening to the correct position. - Two-Stage Repair:
For boys with more severe cases, such as when the urethral opening is near the scrotum, a two-stage approach is used. The first stage involves straightening the penis and preparing the tissue for the new urethra. The second stage, performed several months later, completes the urethral reconstruction.
What to Expect with Catheter Use and Its Removal
At the end of the first-stage procedure, your paediatrician urologist leaves a small tube in the penile shaft to drain your child's urine. This tube is called a catheter or stent.
Typically, it is stitched to secure its position, and a dressing on the penis is made. This catheter helps the surgically formed urine tube to be in place as well as allowing normal draining of the urine into your child’s diaper. Sometimes, a bag is also used once they are given toilet training.
After a week or two, the dressing is removed from the penis and the catheter is removed.
When the urologist removes the catheter, the appearance of the penis might not look natural due to discomfort or swelling. And at the end of the second stage procedure, gradually discomfort wanes out over time and the appearance of the penis begins to look normal.
After surgery care is generally carried out to monitor complications, manage pain, and ensure proper healing.
Hypospadias Repair Complications
The best Paediatric Urologist Dr. Prasanna Venkatesh at NU Hospitals, Bengaluru has successful outcomes of the surgery, however, potential complications are often part of any surgery. The risk may include –
- Urinary tract infection
- Bleeding at the penis (Operated site)
- Urine may exit or leak from different opening i.e. urethral fistula
- Might create a narrow opening called stricture
- Repeated bending of the penis i.e. curved penis
Proper surgical techniques and postoperative care can minimise these risks.
Complications in Later Life
Long-term complications may include urethral strictures and issues with sexual function. Thus, we recommend regular follow-up with your urology doctor as it is important to address urinary problems.
Benefits of Hypospadias repair surgery:
The benefits of hypospadias surgery include:
- Normal Urine flow: This surgery improves the urination of the patient by modifying the urethral opening. It also reduces urine leaks. Parents can be assured that it will make toilet training easier for their child.
- Natural look of the penis: The surgery aims to give the penis a more typical appearance, which can be important for boosting self-confidence and social reasons.
- Sexual Function: As the opening of the urethra is positioned properly and the bent penis is corrected, it can potentially improve sexual function in adulthood.
Recovery time
Recovery from hypospadias surgery typically involves a few weeks of careful monitoring and care. The child may need to be on a catheter for a short period to ensure proper healing of the new urethral channel. Pain and discomfort are managed with medications, and follow-up visits are crucial to monitor healing and address any complications promptly.
Urine output is closely monitored after surgery. Normal urine flow is a positive sign, and if you observe issues like leakage or discomfort with your child it can be promptly addressed.
Conclusion:
Hypospadias repair surgery is a significant procedure that requires careful planning and expert care. Understanding the process, timing, and potential complications helps ensure the best outcomes for patients. Hypospadias surgery is a well-established procedure with a high success rate. It significantly improves the quality of life for affected individuals by addressing both functional and cosmetic concerns.
Hypospadias condition is mostly identified incidentally at the time of birth or during regular health checkups by your paediatrician or urology doctor.
Improve your child's quality of life and functionality by booking an appointment today!
References:
1. Cleveland Clinic: Hypospadias repair
2. NCBI: Overview of Hypospadias repair techniques
3. ResearchGate: Hypospadias publication
