Pediatric Urology: Hypospadias

Hypospadias is a relatively common birth defect found in boys whereby the urinary tract opening is not at the tip of the penis. Hypospadias occurs in about 1:200-300 male births. Associated with this anomaly can be a bend in the penis called chordee. There is a family association with hypospadias such that 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 due to 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. Different degrees of hypospadias exist -- 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 or not there is associated chordee.

On occasion a child may have chordee, or abnormal bend of the penis upon erection, without apparent hypospadias. Like hypospadias, there is a spectrum in the severity and, therefore, repair may be simple or complex.

Reasons For Surgical Repair Hypospadias

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 if 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 must sit on the toilet to urinate.

A straight penis is necessary for normal sexual functioning. This will not be an important issue in the 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 is critical.

Hypospadias Surgery and Post-Operative Care

Hypospadias and chordee may have extreme variations in their severity. Therefore, one operation will not suit the needs of every patient. Due to the variations of this deformity it is critical that a pediatric urologist, one who is well versed with these types of procedures, do the surgical repair. 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 to 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 in the tub 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.