Hypospadias - Signs, Symptoms, Treatment

Hypospadias Details

The goal of any type of hypospadias surgery is to make a normal, straight penis with a urinary channel that ends at or near the tip. The operation mostly involves 4 steps:straightening the shaftmaking the urinary channelpositioning the meatus in the head of the peniscircumcising or reconstructing the foreskinHypospadias repair is often done in a 90-minute (for distal) to 3-hour (for proximal) same-day surgery. In some cases the repair is done in stages. 

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Before Hypospadias

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How it is performed

Most forms of hypospadias can be corrected in a single surgery that's done on an outpatient basis. Some forms of hypospadias will require more than one surgery to correct the defect.When the urethral opening is near the base of the penis, the surgeon may need to use tissue grafts from the foreskin or from the inside of the mouth to reconstruct the urinary channel in the proper position, correcting the hypospadias.

Recovery

Your child will need a couple of visits to the surgeon after surgery. After that, regular follow-up with your child's pediatric urologist is recommended after toilet training and at puberty to check for healing and possible complications.Modern hypospadias surgery results in a penis that works well and looks normal (or nearly normal). Many surgeons leave a small tube ("catheter") in the penis for a few days after surgery to keep urine from touching the fresh repair. The catheter drains into the diaper. Antibiotics are often given while the catheter is in place.Younger boys seem to have less discomfort after repair. When the surgery is done at 6 to 12 months of age, as most pediatric urologists recommend, the child doesn't even remember it. Older boys handle this surgery well, also, especially with the types of drugs we now have to treat pain. In some cases, medication may be needed to treat bladder spasms.

Potential Risks

The complication rate in boys with distal hypospadias repair is less than 1 in 10. Problems happen more often after a proximal correction.The most common problem after surgery is a hole ("fistula") forming in another place on the penis. This is from a new path forming from the urethra to the skin. Scars can also form in the channel or the urethral opening. These scars can interfere with passing urine. If your child complains of urine leaking from a second hole or a slow urinary stream after hypospadias repair, he should see his pediatric urologist.Most complications appear within the first few months after surgery. But fistulas or blocks might not be found for many years. Most problems are easily fixed with surgery after the tissues have healed from the first operation (often at least 6 months).It's not easy to think about more surgery in these unusual cases. But there are options that offer hope for success. Unhealthy scarred tissues from prior operations can be removed and replaced with fresh tissue from another part of the body (most often from inside the cheek). This can create a working urinary channel and still look normal. If your pediatric urologist hasn't used these techniques, he/she will direct you to a center where they're used.

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