Our Summary

Hypospadias is a birth defect in boys where the opening of the urethra (the tube that carries urine from the bladder to the outside of the body) is not located at the tip of the penis. It’s the second most common genital malformation in boys, occurring in about 1 in every 250 male births. The cause of this condition can be due to a variety of factors, including genetics, hormones, and environmental influences.

There are three types of hypospadias, classified by where the urethral opening is located: near the base of the penis (proximal), in the middle of the shaft (middle), or close to the normal position (distal), which is the most common form.

Additional tests are carried out before surgery if the hypospadias is severe, runs in the family, or is associated with other physical abnormalities. These tests help predict how the child will develop during puberty.

Surgery to correct hypospadias is typically performed between 6 months and 12 months of age. The goal of the surgery is to correct the position of the urethral opening, straighten the penis, and improve its appearance. Various surgical techniques are used, including stitching the area directly, using local flaps of skin, or grafting skin or mucous membrane.

However, like any other surgery, there are risks. Between 6% to 30% of boys who undergo this operation experience complications, like the formation of an abnormal channel (fistula) or narrowing of the urethra (stenosis).

Given the delicate nature of hypospadias surgery and its potential impact on the child’s psychological well-being, it’s important that it’s performed by experienced surgeons and that the child is monitored into adulthood.

FAQs

  1. What is hypospadias and how common is it in boys?
  2. What are the surgical techniques used for hypospadias reconstruction?
  3. What examinations are conducted before the surgery for severe hypospadias?

Doctor’s Tip

A helpful tip a doctor might tell a patient about pediatric urologic reconstruction for hypospadias is to ensure that the surgery is performed by an experienced surgeon. This delicate surgery requires skill and precision to minimize the risk of complications such as fistulae and stenoses. It is also important to have thorough pre-surgical evaluations, including endocrine, genetic, and morphological exams, especially in cases of severe hypospadias or associated abnormalities. Additionally, ongoing psychological support for the child is important for their emotional well-being as they grow into adulthood.

Suitable For

Patients who are typically recommended for pediatric urologic reconstruction are those diagnosed with hypospadias, a congenital anomaly that affects the ventral side of the penis and results in an ectopic meatus of the urethra. Additional exams may be performed before surgery in cases of severe hypospadias or if there are other associated abnormalities. Surgical management is usually done between 6 months and 12 months of age to minimize the functional and aesthetic impact of the malformation. Various surgical techniques are available, but the surgery should be performed by experienced surgeons to minimize postoperative complications. Psychological follow-up of these patients is also important throughout their development.

Timeline

Before pediatric urologic reconstruction:

  • Diagnosis of hypospadias is made during routine physical examination or prenatal ultrasound
  • Additional exams such as endocrine, genetic, and morphological tests may be performed to assess the severity and potential associated abnormalities
  • Surgical management is typically scheduled between 6 months and 12 months of age
  • Psychological preparation for the child and their family may be necessary

After pediatric urologic reconstruction:

  • Surgery typically involves penile straightening, urethroplasty, and reconstruction of the ventral side of the penis
  • Various surgical techniques are used, including direct sutures, local flaps, and grafts
  • Postoperative complications, such as fistulae and stenoses, may occur in 6-30% of cases
  • Long-term follow-up is necessary to monitor for any complications or psychological issues in the child as they grow into adulthood.

What to Ask Your Doctor

  1. What is the cause of my child’s hypospadias and are there any additional tests needed to determine any underlying conditions?
  2. What are the different anatomical forms of hypospadias and which form does my child have?
  3. What is the recommended age for surgical management of my child’s hypospadias?
  4. What are the different surgical techniques available for treating hypospadias and which one do you recommend for my child?
  5. What are the potential complications of the surgery and how common are they?
  6. How long is the recovery process after the surgery and what kind of follow-up care will be needed?
  7. Will my child need any additional support or therapy, such as psychological support, after the surgery?
  8. What is the long-term outlook for my child’s condition and what kind of ongoing care will be needed?
  9. Are there any lifestyle or dietary changes that can help support my child’s recovery and overall health?
  10. Are there any resources or support groups available for families of children with hypospadias?

Reference

Authors: Boudaoud N, Pons M, Bouche Pillon Persyn MA, Lefebvre F, Poli Merol ML, Francois C. Journal: Ann Chir Plast Esthet. 2016 Oct;61(5):439-449. doi: 10.1016/j.anplas.2016.03.007. Epub 2016 May 10. PMID: 27177771