What is hypospadias?
Hypospadias is one of the most common conditions referred to a pediatric urologist. It is a condition where the urinary channel in a boy (called the "urethra"), does not come out at the tip of the penis. The cause is usually not known, although it does occur in some families. About 1 out of every 300 boys is born with this condition. The opening to the urinary channel may come out anywhere along the undersurface of the shaft of the penis or even as far back as beneath the scrotum. The foreskin on a penis with hypospadias is also abnormal. Frequently, a bend in the penis toward the boy's feet occurs with hypospadias.
Is surgery necessary?
If the opening of the hypospadias is out along the shaft, and the penis is straight, the only reason to operate is to make it look normal. If the opening of the urethra is further back on the penis or scrotum, or if it has a severe bend in it, then it may interfere with urination, sexual intercourse and fertility.
When should surgery be performed?
Most pediatric urologists believe the ideal timing for correction of hypospadias is between 6 and 18 months of age. It is believed that both the adverse psychological effects of parental separation as well as genital awareness are decreased at this age.
What is the surgery like?
There are many different techniques for hypospadias repair. The best technique depends on the child's specific form of hypospadias and the pediatric urologist repairing the hypospadias should be familiar with these different techniques. With modern techniques, almost all children with hypospadias are now treated in one operation. Your child will go home on the same day of surgery with a bandage on his penis that will stay in place for about two days. Frequently a tube (called a "stent") is also left in the penis. This tube is held in place with one stitch and will be removed in our clinic in about 7 to 10 days.
What are some of the specific complications with hypospadias surgery?
The most common complication following hypospadias surgery is a hole ("fistula") that opens up along the newly created urinary channel. This results in urine coming out at the tip of the penis as well through the fistula. If this occurs, a second operation will be required to close the fistula. Laser surgery may reduce the incidence of fistula formation and is a new technique being developed at the University of Iowa. Another complication occurs when the new urethral opening made at the end of the penis scars down and becomes too small. This also would require a second surgery. The incidence of both these complications has decreased with modern techniques of hypospadias surgery.

Source: April 2011

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