Hypospadias

Hypospadias is a congenital abnormality or a birth defect in which the urethra opens on the underside of the child’s penis rather than at the tip. The tube that drains urine from the bladder and allows it to leave the body is the urethra.

Hypospadias is typically a common condition that does not interfere with the infant's care. A surgical procedure is mostly done to restore the child's penis to its standard appearance. Most babies can experience normal urination as well as reproduction after successfully treating hypospadias.

Types of Hypospadias

Hypospadias can be classified into the following types:

Distal or glandular hypospadias: This is the most common form of hypospadias whereby the opening is close to the tip of the penis.
Midshaft hypospadias: This is when an opening is present in the middle to lower penis shaft.
Penoscrotal hypospadias: This is whereby an opening is located in the area where the penis and scrotum meet.
Perineal hypospadias: This occurs if the opening is found at the back of the scrotal sac. They are the most serious and uncommon types of hypospadias.

Signs and Symptoms of Hypospadias

Symptoms of hypospadias in babies include:

Chordee: Abnormal downward curving of the penis.
Undescended testicle: This is where one of the testicles does not descend completely into the scrotum (this is about 10 percent of all cases)
Undeveloped foreskin: This is where the skin covering the tip of the penis isn't fully developed. Hence, circumcision should not be performed on babies who have hypospadias.
Urinating abnormally: Urine does not spray in the usual straight stream.

The majority of hypospadias in newborns are diagnosed when they are still in the clinic shortly after birth. On the other hand, minor urethral opening displacement can be subtle and difficult to detect. Consult a pediatrician if you are concerned about your child's penis appearance or if he is having urination problems.

Causes of Hypospadias

Hypospadias is a congenital disorder present at birth. Some hormones usually stimulate the development of the urethra as well as the foreskin in a male fetus as the penis forms. Hypospadias can thus occur when the process of these hormones fails, leading to abnormal development of the urethra.

The actual causes of hypospadias are not known in the majority of cases. Hypospadias can at times be inherited, although the environment can play a role as well.

Risk Factors of Hypospadias

While the exact cause of hypospadias remains unknown, the following factors can contribute to the development of the condition:

Genetics: Some genetic variations may be involved in the disruption of the specific hormones stimulating the development of male genitals.
The child’s family history: Babies who have a family history of the condition are more likely to develop it.
Maternal age of 35 years and above: Certain research studies indicate that male babies born to mothers over the age of 35 may have a higher possibility of hypospadias.
Prolonged exposure to some substances while pregnant: There are a few theories that hypospadias is linked to exposure of the mother to some hormones or compounds like pesticides or industrial chemicals. However, more research is necessary to verify this speculation.

Hypospadias Diagnosis

The baby’s pediatrician can detect hypospadias condition by conducting a thorough physical examination. If necessary, he or she can refer the child to a pediatric urologist (a surgeon specializing in urinary and genital conditions) for more assessment. The healthcare facilities with specialized teams can assist you in evaluating the available options and providing care.

Sometimes, the urethral opening is abnormal, while the testicles can’t be felt during examination. In such situations, the genitals might be complex to distinguish as male or female, a condition called ambiguous genitalia. Hence, additional analysis from a multidisciplinary team is advised in this case.

Treatment of Hypospadias

Some types of hypospadias are relatively minor, that they do not necessitate surgery. In other cases, hypospadias treatment includes a surgical procedure to relocate the urethral opening and straighten the penis shaft if necessary. Typically, surgery is performed when the child is between 6 to 12 months.

Circumcision should be avoided if the penis appears abnormal. When hypospadias is discovered during circumcision, then the treatment procedure has to be done. A pediatric urologist should be consulted in both cases.

Hypospadias Surgery

The majority of hypospadias types can be treated in one outpatient surgical procedure. However, other types of hypospadias will necessitate more than one correction procedure to rectify the defect.

If the urethral opening is close to the bottom of the penis, the pediatric surgeon might have to use the tissue grafts. These tissue grafts are obtained from the foreskin or the inner part of the mouth. They help reconstruct the urinary channel, restore it into the appropriate position, and correct the hypospadias.

Hypospadias correction is frequently performed in a 90-minute to 3-hour same-day procedure. In other cases, repairs are carried out in stages. These normally involve the proximal issues of severe chordee. Before creating the urinary channel, the pediatric surgeon mostly prefers to straighten the penis.

Other surgeons prefer to perform hypospadias operations on full-term or healthy boys aged 6 to 12 months. However, hypospadias can be corrected in children regardless of age, as well as in adults. For small penis, the doctor may recommend taking testosterone (male hormone) before surgery.

A well-done hypospadias repair often lasts a lifetime. In addition, it will have the ability to adjust during puberty as the penis enlarges.

Hypospadias Surgery Results

The surgical procedure is usually a success in the majority of cases. The penis tends to appear normal following operation, and the child has normal urination as well as reproduction.

In rare cases, a hole or fistula may form alongside the underside of the child’s penis (the area in which the new urinary canal was formed). This can lead to leakage of the urine. There is rarely an issue with wound recovery and scarring. Such complications might necessitate further surgery to correct.

During recovery, your child will require a couple of visits and checkups with the surgeon. Following that, it is essential that your child regularly see his or her pediatric urologist after toilet training and during puberty to examine the healing and other potential complications.

Caring for the Wound after Hypospadias Surgery

Hypospadias treatment wounds do not necessitate any specialized care to recover properly. The pediatric surgeon can select from a variety of bandage kinds or use none at all. He or she will then direct you on how to care for your child’s wound and bathe him.

The baby's catheter can be left in place to help drain into the diapers if he has one. Diapers can then be changed normally. If he is older, the catheter might be attached to a bag. The doctor or nurse will show you how to empty the urine bag appropriately. Catheters are frequently left in place for about five days or two weeks.

Prevention of Hypospadias

Pregnant women can limit their child's risk of hypospadias by leading a healthy lifestyle. They should thus consider the following measures:

Avoid smoking or consuming alcohol
Keeping a healthy weight
Taking folic acid (400 to 800 micrograms per day) during pregnancy
Visiting your doctor for routine checkups when pregnant

Complications of Hypospadias

For children who undergo distal hypospadias treatment, the complication rate is less than one in ten. Following a proximal repair, problems tend to occur more frequently.

After treatment, the most prevalent issue is the formation of a fistula or a hole in a different part of the penis. This happens due to the formation of a new channel from the urethra towards the skin. Also, scars can develop in the opening of the urethra or channel. These scars could make it difficult to pass urine. When the child experiences urine leakage from the other hole or a slower urinary stream following hypospadias surgery, he should consult a pediatric urologist.

The majority of complications occur after the first few weeks or months of surgery. However, fistulas or blockages may not be discovered for several years. Once the tissues have recovered from the first procedure, most issues are easily corrected through surgery (usually about six months).

In such unusual situations, it's difficult to consider additional surgery. However, there are various options with high success rates. Scarred unhealthy tissues from previous surgery could be eliminated. They are then replaced with new tissue obtained from a different area of the body (mostly from the inside of the mouth). This may result in a functional urinary channel while still appearing normal. If the child’s pediatric surgeon does not use these approaches, he or she can refer you to a facility that does.

Conclusion

Hypospadias is a birth defect that causes the urethra's hole to be positioned somewhere else but not the head of the penis. If left untreated, hypospadias could lead to problems when it comes to urination and reproduction functions.

On the other hand, hypospadias treatment is highly effective in most cases. Surgery aims to straighten the penis and position the hole correctly. Furthermore, hypospadias repair normally lasts a lifetime.