Hypospadias

Hypospadias is a relatively common birth defect found in boys, in which the urinary tract opening is not at the tip of the penis. Hypospadias occurs in about 1 in 200–300 male births. Associated with this anomaly can be a bend in the penis called chordee. There is a genetic association with hypospadias; in a family with hypospadias, there is a 25% chance of finding another family member with hypospadias.

Associated with hypospadias is a foreskin that is only “half” present because of the absence of the lower portion. Children with hypospadias should not be routinely circumcised at birth until they have been evaluated by a pediatric urologist. There are varying degrees of hypospadias—some quite minor and others more severe. The type of hypospadias is named according to the anatomic location of the defect, but one must always determine whether there is associated chordee. On occasion, a child may have chordee without apparent hypospadia. Usually this is caused by skin tethering and can typically be fixed with an uncomplicated surgery.

Reasons For Repair

Surgical correction of hypospadias involves straightening of any bend and extending the urinary tube (urethra) out to the tip of the penis (glans). It is important for boys to be able to stand to urinate. If the urethra ends before it reaches the glans, a boy may be unable to stand to urinate with a direct stream. It may be a socially difficult problem for a boy who is unable to sit down on the toilet to urinate. A straight penis also is necessary for normal sexual functioning. This will not be an important issue in one's younger years but will be of critical importance later in life. The best time for surgical repair is during early childhood—thus the timing of your referral.

Surgical Correction and Postoperative Care

Hypospadias and chordee may have extreme variations in their severity; therefore, the same operation will not suit the needs of every patient. Because of the variations of this deformity, it is critical that the surgical repair be done by a pediatric urology surgeon well versed with these types of procedures. It is not unusual for a child to need a second-stage repair, especially for the more severe forms of this disorder.

A plastic tube called a stent or catheter may be temporarily left in the penis to act as a scaffold and ensure urine drainage during the healing phase. Because dissolvable suture is used to hold this tube in place, the tube typically falls out within 7–10 days after surgery. If it has not fallen out by 10 days, we will have you come to the clinic for simple removal. A dressing will also be applied to the penis to protect the repair for the first several days after surgery.This should fall off during bathing 2–3 days after surgery .A simple over-the-counter antibiotic ointment can be applied to the penis for the next 5–7 days as needed.