Hypospadias

What is Hypospadias?

It is a condition where urethral opening (from where the urine comes out) is underneath the penis. This condition only affects boys not in girls. Urethra is a tube which drains urine from bladder to outside of body.
Most of the time urinary opening is just underneath penis. Sometimes it could be at base or rarely below it also.

Hypospadias has three components:

• Urinary opening underneath penis
• Foreskin is deficient on front side
• There may be curvature or bent in penis

What is the cause of hypospadias?

As of now we don’t know exact reason of hypospadias. Its incidence all over world in increasing. Currently estimated to be 1 in 300 boys. Occasionally it may be common in some families or in premature boys. It may be a part of other genetic issues (syndrome). Environment also plays role in formation of hypospadias. Exposure of mother during pregnancy of pesticides or industrial chemicals may also contribute to this.

What are symptoms of hypospadias?

• Abnormal urinary opening
• Forward curvature of penis called as chordee
• Absent foreskin on front side
• Spraying of urine while passing urine

How to diagnose Hypospadias?

Generally diagnosis is done at time of birth. Mild variety may be missed at birth. As with overall growth, growth of penis also happens and may be noticed little late in regular baby check. It is strongly recommended not to do circumcision if you notice hypospadias.

Will my boy will have any other associated anomalies with hypospadias?

Commonly hypospadias is a single anomaly. Sometimes it may be associated with hernia, hydrocele or undescended testes. Your pediatric surgeon or pediatric urologist should be able to diagnose these during examination of child.
Most of the time hypospadias is a mild variety called as distal where urinary opening is just underneath penis. In some where it is more at base of penis or further below it and if associated with bilateral undescended testes then your surgeon may want to involve a pediatric endocrinologist to evaluate and manage serious underlying medical condition. You can discuss more about this with your surgeon.

What are complications of hypospadias if not treated?

• Appearance will be not normal, may cause psychological disturbance in long term
• Problems using toilet. Urine may spray over pants
• Evident curvature when there is an erection of penis
• Ejaculation may not be proper leading to reproduction problem

When to plan for surgery?

In most of the boys there should not be any issues passing urine after birth. Surgery is usually done between 6 months to 12 months of age.

What are the risks associated with surgery?

Every anaesthesia is a risk to child, but this risk is small. Your anaesthetist is well experience in handling children and treat complications. After surgery some boys may feel sick, vomit or may have sore throat. All this is temporary and will go away.
You should expect some bruising, discoloration and swelling over penis. Occasionally minor bleeding can happen, major bleeding is rare. When surgery is done for urinary opening more distally on penis, the success is good. Occasionally urine may come out from one more hole, infection may cause some stitches to give away leading to one more operation. A catheter (tube) is left in bladder which will drain urine after surgery, surgeon will decide when to remove it. Occasionally these catheters can get blocked or may come out early.
Your surgeon may decide to do two different operations to begin with depending upon what he or she observes during examination. Generally in first surgery the curvature is corrected and in second surgery urinary channel in made.
Overall dictum is that complications or risks are higher more proximal is urinary opening along with curvature of penis.
In more proximal urinary opening sometimes urinary channel can become narrow in long term. It may need dilatation of channel or occasionally one more operation.

What happens after operation?

Surgery takes upto 2 hours, sometimes more. Once child is awake after surgery feeding can be started. You will see dressing on top of penis and urine coming out through a catheter in nappy. Paracetamol can be used for pain management. Since there is catheter in bladder, it may cause bladder spasms leading to pain. Your surgeon will prescribe special antispasmodic medicine. Next day you will be discharged with all detail instructions.

What happens when I go home?

Generally children are more comfortable in home. Encourage them to walk around, eat normally and give plenty of fluids, juices. If you see any soakage or stool around the dressing site than you can dab off with wipes. There is no need to give shower till catheter is in place. Use pain medication for 2-3 days. Occasionally dressing may have some blood stains on it.

When should I see the doctor?

You should see your doctor as per discharge instructions.
You should see doctor early in situations where

• Catheter is not draining urine that means catheter is blocked.
• Dressing is coming off completely
• Child has excessive pain or fever in spite of medications
• Catheter falls off
• After removing dressing the area is still swollen, looking red or feeling hot, rarely pus may coming out of it
• He is having trouble passing urine