Hypospadias is a common congenital condition where there is incomplete closure of the urethra, resulting in misplacement of the urethral opening. In recent times, there has been an increase in the number of boys affected by hypospadias. Different studies have reported varying figures; the average is about 1 in 300. Children with hypospadias are classified into different groups based on the location of the urethral opening along the penis. The complexity of the condition grows as the opening is located further away from the tip of the penis.
Types of Hypospadias
- Anterior Defect: This is located near the tip of the penis, towards the distal end of the glans. Approximately half of all cases fall into this category. Correction of this type is generally simpler, and sometimes correction might not even be necessary if the opening allows normal urine flow without problems.
- Midshaft Defect: This extends from the scrotum to the middle portion of the penis. Around 20% of cases are of this type.
- Posterior Defect: This occurs from the base of the scrotum to the perineal raphe (lower part of the scrotum). About 30% of cases fall into this category. Correcting this type of defect is challenging, and satisfactory outcomes are achieved after the first surgery in only about 50% of cases. Additional surgeries are often required for optimal results.
Hypospadias can also affect the foreskin (the tissue that surrounds the penis), causing it to form only on the upper part of the penis and not on the lower part, causing the organ to appear circumcised. The foreskin can play a key role in reconstructive surgery, helping to decrease significantly the range of post-surgical complications. It is therefore essential that a pediatric urologist be consulted in even the mildest cases of hypospadias, to determine whether a regular circumcision (brit milah) can be performed by a mohel, or whether it should be performed as part of the surgery to correct hypospadias. (In the latter case, the parents are usually permitted to be present in the surgical theater during the procedure and to actively participate in the brit milah.)
Treatment
Treatment for hypospadias is typically surgical. While in the past surgeries were often performed at around age 3, corrective surgeries are now usually performed between 6 and 12 months of age in view of the psychological and emotional challenges entailed in genital surgery at a later age.
In most cases, a single surgery corrects the defect and improves the aesthetic and functional shape of the penis. The majority of surgeries result in good urinary and sexual function after the procedure, without fertility issues.
Complications
Apart from the complications associated with any surgical procedure, such as infection and wound leakage, there are specific complications associated with hypospadias repair. One common complication is a urethral fistula or stricture, which involves urine leakage at the suture site of the newly reconstructed urethra. This requires additional surgery to address the leakage and ensure proper urine flow through the reconstructed opening. In rare cases, the repair might need to be redone.
