Our Summary

Hypospadias is a birth defect in boys where the opening of the urethra is not located at the tip of the penis. The repair of severe hypospadias is a complex procedure and there is ongoing debate over whether a one-step or two-step approach is most effective.

This study looks at the experiences of a single surgeon who performed a two-step repair on 301 boys between 1998 and 2010. The first step involved straightening the penis and using a graft to create a new urethral plate. The second step, which took place after the graft had time to mature, involved creating a new tube for urine to pass through.

The results showed that the graft was successful in all but one case of the primary repairs, and only four cases in the revision repairs. These results are significantly lower than the complication rates reported in other studies.

The study concluded that the two-step repair process is a safe and effective treatment for severe primary and failed primary hypospadias. It not only offers low rates of complications, but also excellent cosmetic results. The authors recommend this two-step repair process as the preferred treatment for these types of penile deformities.

FAQs

  1. What is hypospadias and how is it repaired?
  2. What were the findings of the study on the two-step repair process for severe hypospadias?
  3. Why do the authors recommend the two-step repair process as the preferred treatment for severe hypospadias?

Doctor’s Tip

One helpful tip a doctor might give to a patient undergoing hypospadias repair is to follow all post-operative care instructions carefully. This may include keeping the surgical area clean and dry, avoiding strenuous activities, and taking prescribed medications as directed. It is important to attend all follow-up appointments with the surgeon to monitor healing and address any concerns. By following these instructions, patients can help ensure a successful outcome and minimize the risk of complications.

Suitable For

Patients who are typically recommended for hypospadias repair are those with severe hypospadias, which can lead to problems with urination, sexual function, and psychological well-being. These patients may have a noticeable curvature of the penis, a misplaced urethral opening, or other abnormalities that affect the appearance and function of the penis. In some cases, hypospadias repair may also be recommended for patients with failed previous repair attempts or complications from previous surgeries. It is important for patients and their families to consult with a urologist or pediatric surgeon to determine the best treatment approach for their specific situation.

Timeline

Before the hypospadias repair:

  • Patient is born with hypospadias, a birth defect where the opening of the urethra is not located at the tip of the penis
  • Patient may experience difficulty with urination, abnormal spraying of urine, and potential psychological issues related to the appearance of the penis
  • Patient and parents may consult with a pediatric urologist to discuss treatment options

After the hypospadias repair:

  • Patient undergoes a two-step repair process involving straightening the penis and creating a new urethral plate using a graft
  • Patient waits for the graft to mature before undergoing the second step of creating a new tube for urine to pass through
  • Patient may experience some discomfort and swelling following the surgery
  • Patient will have follow-up appointments with the surgeon to monitor healing and address any complications
  • Patient will eventually experience improved urinary function and a more normal appearance of the penis

What to Ask Your Doctor

Some questions a patient should ask their doctor about hypospadias repair include:

  1. What is the success rate of the two-step repair process compared to other treatment options?
  2. What are the potential complications associated with the two-step repair process?
  3. What is the recovery process like after each step of the repair?
  4. How long will it take for my child to fully recover from the surgery?
  5. Will my child need additional surgeries or follow-up appointments after the repair?
  6. What are the long-term effects or risks associated with hypospadias repair?
  7. Are there any lifestyle changes or restrictions my child will need to follow after the surgery?
  8. How experienced are you in performing hypospadias repair surgeries?
  9. Can you provide me with before and after photos of previous patients who have undergone the two-step repair process?
  10. Are there any alternative treatments or approaches to consider for my child’s hypospadias?

Reference

Authors: Pfistermüller KL, Manoharan S, Desai D, Cuckow PM. Journal: J Pediatr Urol. 2017 Feb;13(1):35.e1-35.e7. doi: 10.1016/j.jpurol.2016.08.014. Epub 2016 Sep 29. PMID: 27746246