Hypospadias repair

Overview

Hypospadias is a congenital condition characterized by an abnormal development of the urethra in the penis. Normally, the urethral opening, or meatus, is located at the tip of the penis, but in individuals with hypospadias, it forms in an atypical location. This can range from near the head of the penis (subcoronal) to along the penile shaft (midshaft), or at the junction of the penis and scrotum (penoscrotal).

In addition to the misplaced meatus, hypospadias can be associated with other anatomical abnormalities. Some children with this condition may have congenital penile curvature, known as chordee, which causes the penis to bend. Another related condition is penoscrotal transposition, where the scrotum develops above the penis instead of below it. These associated abnormalities may also require surgical correction.

Hypospadias repair is a surgical procedure designed to correct the position of the urethral opening and address any additional congenital issues. The surgery typically involves repositioning the meatus to its normal location and straightening the penis if necessary. Early diagnosis and treatment are essential for achieving the best outcomes, ensuring proper urinary function and an improved cosmetic appearance.

Reasons for undergoing the procedure

The healthcare providers advise having a hypospadias repair performed on your child between the ages of six months and two years if they are diagnosed with the condition. It is up to you as a parent to determine whether or not your child will have the surgery.

Hypospadias repair is not always mandatory. One of the primary goals of this procedure is to enhance ease and comfort during urination and ejaculation. Your child might not need surgery to fix their mild hypospadias.

Risk

Surgical operations are not without risk. Following a hypopadias repair, some risks include:

• Anesthesia reaction.
• Bruising or swelling.
• Infection.
• Mass of clotted blood or hematoma.
• Scarring that is unfavorable or alters sensation (feeling).

Potential risks following hypospadias repair may include:

• Break down of wound: It’s possible that the skin transplant won’t properly blend in with the new location.
• Urethrocutaneous fistula: A hole that develops in your child’s penis that extends down to their urethra is known as an urethrocutaneous fistula. Stool may come out of a fistula. Months or even years after a hypospadias surgery, a fistula may develop.
• Urethral stricture: Their urethra may constrict due to scarring. A small urethra can cause pressure on the kidneys, prostate, bladder, and testicles (testes), as well as alter the flow of urine.
• Urethral diverticulum: Their urethra bulges, creating a pouch filled with fluid.
• Shortened penis: Your child’s penis may get shorter if they have a hypospadias correction during or after puberty.
• Recurrent curvature of the penis: Their penis may occasionally revert to its original curvy form following surgery.

Before the procedure

Before your child undergoes hypospadias repair, you’ll have an appointment with their healthcare provider. During this visit, the provider will assess your child’s overall health and take vital signs, including blood pressure, temperature, and pulse.

They will also conduct a physical examination of your child’s penis. During this examination, they will:

• Identify the location of the opening in their penis.
• Inquire about their urine flow strength, direction, and any issues with spraying or leaking.
• Assess the degree of curvature when your child’s penis is erect.
• Conduct a cystoscopy or urethrogram if needed, which helps detect any potential blockages.

All prescription and over-the-counter (OTC) medications your child takes, including herbal supplements, should be disclosed to their healthcare provider. The risk of bleeding can be increased by medications such as aspirin, anti-inflammatory drugs, and certain herbal remedies.

Notify your child’s healthcare provider of any reactions your child may have. Add all known allergies, including those to foods, latex, iodine, and isopropyl alcohol, as well as medications and skin cleansers.

Your child’s healthcare provider may recommend testosterone injections in severe cases to safely increase the width and length of the penis before hypospadias surgery, potentially improving surgical outcomes.

You’ll receive specific instructions from your healthcare provider regarding fasting guidelines before surgery, which vary based on your child’s age. It’s crucial to follow these instructions carefully.
During anesthesia, if your child has food or fluids in their stomach, there’s a risk of vomiting and subsequent pulmonary aspiration, where food or liquid could enter the lungs, potentially leading to asphyxia or pneumonia.

Your child’s healthcare provider will guide you through these processes and may offer suggestions to help your child relax before surgery. Even if your child may not fully understand the situation due to their age or cognitive ability, they can still pick up on your nonverbal cues. Remaining calm can help your child feel more comfortable and reassured.

During the procedure

General anesthesia will be used b to sedate the child. They won’t move, be awake, or experience any discomfort while the surgery is being done.

When your child is asleep, the surgeon will remove a portion of your child’s foreskin, which is the skin covering the head of the penis, using a sharp, sterile knife (scalpel). Then, in order to extend it, they will create a tube out of the foreskin and join it to your child’s urethra. They are able to move the meatus to the tip of your child’s penis since they have a longer urethra.

Typically, a catheter (stent) is inserted into your child’s urethra. A catheter is a flexible, hollow tube that is often constructed from silicone, rubber, or another type of medical-grade substance. When the urethra of your child heals, a catheter helps it keep its form. It also removes urine. After the hypospadias repair, the catheter might be in place for as long as two weeks.

Your child’s surgeon may also perform additional repairs. Other procedures may include:

• Urethroplasty: This procedure reconstructs the urethra to ensure urine and semen flow as far forward as possible.
• Meatoplasty (glanuloplasty): The head (glans) of the penis is reconstructed to correspond with the newly created urethral opening during a meatoplasty procedure.
• Scroplasty: The scrotum has been repaired by a scrotoplasty.

The surgeon utilizes dissolvable stitches to close the incisions (cuts). These stitches are designed to dissolve within approximately two weeks.

Hypospadias repair can be either a one- or two-stage procedure depending on the severity. Mild cases of hypospadias typically require only a one-stage repair, which involves a single surgery.
Your child will require a two-stage hypospadias correction if they have penoscrotal hypopadias. This entails having two procedures, usually six months apart. During this process, the urologist could use your child’s mouth tissue to help build their new urethra.

After the procedure

After a hypospadias repair, healthcare providers will secure the stent and cover your child’s stitches. In the recovery room, a healthcare team will monitor your child’s general health until they wake up. Since most hypospadias repairs are outpatient procedures, your child can typically go home the same day.

You’ll receive instructions from healthcare providers on how to assist your child’s recovery, especially during the first week post-surgery. They may prescribe pain relief medication for your child.

Your child will be discharged once healthcare providers confirm they are stable and no longer require monitoring.

Outcome

Success rates for hypospadias repairs are very high. Your child’s penis will continue to grow and function normally and most repairs last a lifetime.

The following are some advantages to hypospadias repair:

• Reconstructing your child’s urethra to the tip of their penis to enable regular ejaculation and urination.
• Making their penis straighter.
• Improved its appearance.

After hypospadias correction, most kids experience tiredness. They might sleep more during the course of the next few days. They heal more quickly while they sleep.
The recovery process times can vary, so keep in mind that your child’s body is unique. Usually, bruising and swelling go away in two weeks or less. In approximately six weeks, many children recover completely.

If your child has any unusual signs or symptoms following a hypospadias repair, contact their healthcare provider immediately. These indications could consist of:

• Fever.
• Heavy bleeding in the affected areas.
• Increased pain.
• Infection.
• Swelling.
• The catheter dislodge.
• Trouble peeing.
• Urine is leaking around the catheter.
• Vomiting three or more times a day.
• Your child does not urinate.

Schedule regular follow-up appointments with your child’s healthcare provider to monitor the healing of their penis and any other affected areas after hypospadias repair. Depending on the severity of the condition, additional procedures may be necessary.