In the course of last few years of dedicated practice in Pediatric Urology and Hypospadiology, We realized that anxious parents have a lot of questions and they forget to ask many of them when they are consulting us in the clinic. Here I have put down some of these question/ answers and I hope it helps the parents in participating better in the care of their little ones.All in all it's a team effort.

New molecular research, better understanding, long term follow-up data and better surgical techniques have allowed us to offer a more comprehensive approach including counseling, planned surgical correction and appropriate gender assignment in these babies.

This is a condition where the urinary opening (pee hole) is not in the correct place but located on the underneath surface of the penis. The type of hypospadias is described by where the opening is. The mildest form (glanular) is where the opening is on the glans (see diagram). In moderate hypospadias the opening comes where the glans meets the body of the penis (coronal and sub-coronal). Openings farther back (on the penis itself or at the base of the penis) are the severe varieties. In addition to the hole being in the wrong place, the foreskin is often incompletely formed on the undersurface and looks like a hood on the top. Sometimes the penis is bent downwards (chordee) usually due to tight skin but sometimes due to abnormality of the body of the penis.

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anatomy_Hypospadias

Yes. It occurs to some degree in 1 in 150 to 200 boys. In India every year more than 80,000 babies are born with hypospadias.

Mild to moderate hypospadias are rarely associated with other abnormalities, so no further tests are required. If the hypospadias is very severe or there is also an undescended testis or penile size is very small then further testing is required.

The urinary pipe called urethra normally forms from a strip of special skin forming itself into a tube on the under side of the penis. It closes up rather like a zip fastener pulling closed from the back end to the tip of the penis. For some reason the end part of the tube fails to form and remains as a flat plate. The underlying cause is unknown in most cases. There are several theories including increased female hormone like substances in the environment causing mild forms of hypospadias. Very occasionally, it seems to run in families.

Surgery may be required for 2 reasons:

  1. To make everything work properly, i.e. to make the urine comes out from the tip and to make the penis straight.
  2. For cosmetic reasons.

If the boy can pass urine forwards then the operation is purely cosmetic. However, if it is not operated then there is a risk of your child becoming upset by the appearance as he gets older. Surgical results are best in the first year of life.

Ideal age for surgery in most of the hypospadias is between 6-12 months of age. If there are any co-existing problems, then surgery may be delayed till they are sorted out.

Anesthesia is relatively safe after 6 months of age, that’s why we wait till that age. In infancy the babies are still in diapers, so managing them post surgery at home is very easy for the parents. The catheter can just drip into the diapers and the baby can be sent home, the evening of surgery or maximum the next day. Further the skin and tissues are very pliable and heal very well at this age. Most importantly, erections and infections are also less of an issue at such a young age. Older kids have painful erections after surgery and also the post operative care may be difficult.

Most of isolated hypospadias once corrected do not have long-term sequences. Only cases where further investigation is warranted to look for fertility issues are the cases where the hypospadias is very severe, there is associated undescended testis or the gender itself is in question. This can be ascertained by a set of certain investigations which your doctor will explain to you if required.

Babies are checked for fitness for anesthesia by a pediatrician/ anesthetist. A couple of blood tests may be required. Any history of bleeding/blood disorder in the family should be asked. The baby should be free from any infection elsewhere (cold, cough, diarrhea, skin infections etc.). Generally babies are kept empty stomach for 4-6 hours before surgery, as it is a requirement for anesthesia. Bathing is advisable in the morning of surgery.

Surgery time depends upon the severity of the hypospadias. Generally total time spent in the operation room (inclusive of anesthesia time) for a penile hypospadias is between 2-3 hours and more for severe hypospadias sometimes even 4-5 hours.



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