Male Hypospadias

What is Hypospadias?

Hypospadias is a male birth defect in which the opening of the tube that carries urine from the body (urethra) develops abnormally, usually on the underside of the penis. The opening can occur anywhere from just below the end of the penis to the scrotum. In most cases, the cause of this birth defect is not fully understood. Treatment with hormones such

as progesterone during pregnancy may increase the risk of hypospadias. Certain hormonal fluctuations, such as failure of the fetal testes to produce enough testosterone or the failure of the body to respond to testosterone, increase the risk of hypospadias and other genetic problems.

Mild hypospadias usually does not cause symptoms, especially in newborns and young children. If it's more severe, a male may have problems such as spraying urine, having difficulty directing the urine stream, and having erections that are not straight. In some cases, this defect may make it impossible to urinate while standing.

Hypospadias is usually diagnosed in males at birth. Upon examination, the foreskin is usually incomplete and the urethral opening is misplaced. Mild hypospadias may not be diagnosed unless removal of the foreskin (circumcision) is performed.

Some pediatricians perform ‘partial circumcisions’. In this situation the pediatrician begins the circumcision procedure, and, after exposure of the glans, identifies a hypospadias.

Due to swelling after the procedure, the consequences of a partial circumcision may look bothersome at first, but after several days or weeks the inflammation reduces and the penis appears much better over time.

Male hypospadias is treated for several reasons and is conducted in full term or healthy boys, who are in between 3 months to 18 months. However, the repair can be performed also in childhood and sometimes possibly in the adulthood. Sometimes treatment for testosterone hormone is done before the surgery in case the opening is proximal.

The surgery is done to make the penis to straight to normal position having urinary channel at the head tip ends of the penis. The surgery is performed in four steps.

• Straightening the shaft

• Creation of the urinary channel

• Positioning the opening of the urethral in the head

• Reconstruction or circumcision of the foreskin

The surgery for hypospadias repair takes 90 minutes to 3 hours. It is done usually in stages. The surgery is usually performed with spinal anesthesia or general anesthesia. Urologists perform certain tasks during the surgery. They straighten the shaft separately before the urinary channel is constructed.

Hypospadias is done in first degree, second degree or third degree. First degree is a mere cosmetic defect, in which there is hardly any effect on the function. However, in certain cases, like the direction of the stream of the urine is the exceptional condition in the first degree. If it is not corrected the following second degree or third degree will make the urination to become messy, and may create the problems related to the fertility. Sometimes it may interfere with the erections. In some countries, especially in the developed countries, most of the hypospadias repair surgery is performed during the infancy itself. Most of the time, first degree and second degree surgical repair is successful, when performed in one procedure itself. The same procedure is usually done by plastic surgeon or pediatric urologists during the year of individual’s life.

Before the surgery is performed, sometimes it would be necessary to give human chorionic gonadotropin injection or testosterone injections, in case the penis is found very small. If the hypospadias is severe, multiple procedures may be required and sometimes mucosal grafting is also required. It is important to avoid circumcision before the repair is performed.

For the hypospadias repair, many of the surgeons prefer the fresh repair to be not used immediately, by the patient. After the surgery, for the first few days it is connected with a small catheter, which directly connects to the diaper. So, the patient does not need to urinate through the fresh repair. While the catheter has been connected, antibiotics and also antispasmodics for bladder are given.

After the surgery is performed, the schedule for the follow up visits is usually dependent upon the urologists.

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