Overview of Hypospadias Male Birth Defect

Hypospadias is a male birth defect where the opening of the urinary tract, the urethra, is not located at the tip of the penis but opens partway up. Hypospadias affects approximately one in every 200 male births in the United States with varying degrees of severity. Hypospadias is more likely to happen if a close family member has experienced the same defect.

A new born sleeping at the maternity ward
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Treatment

Hypospadias is corrected surgically under a general anesthetic. The type of surgery depends on the severity of the condition. These repairs can be relatively straightforward or can be complex, involving urethral reconstruction. Sometimes the penis might also be curved—a condition known as chordee—which can be corrected surgically during the operation for hypospadias.

The purpose of hypospadias repair is to create a straight penis with the opening of the urethra in a normal position. Mild cases can be treated on an outpatient basis, but sometimes inpatient treatment may be required, especially where chordee is also present.

Because boys stand to urinate, it is important that the urinary stream is easily controllable. Lack of control due to hypospadias can lead to acute social embarrassment. This is one of the reasons that it is ideally treated in infancy, preferably between the ages of six and 18 months of age. An early surgical correction means that psychological trauma can be minimized. Small children are usually good healers and the parents can be shown the necessary postoperative wound care.

Recovery time depends on the severity of the problem and the complexity of the surgery.

Postoperative Care

  • General anesthetic side effectsAs with any surgical procedure that requires a general anesthetic, side effects can occur. Any possible complications will be explained by your anesthetist, pediatrician or genitourinary surgeon prior to the surgical procedure.
  • Postoperative bleeding: Any postoperative bleeding should be reported to the surgeon or doctor in charge of postoperative care. Generally, blood on the dressing the size of a small coin can be expected.
  • Postoperative bladder spasm: Spasms of the bladder sometimes occur when an indwelling catheter is present. This is usually treated with antispasmodic medication.
  • Postoperative infection: Infection is a common side effect at the site of the surgery. This can be prevented or minimized by good hygiene of any postoperative dressings or the skin site. Any redness, swelling or the presence of pus must be reported to the doctor. Sometimes in more severe cases of infection, it may be treated with antibiotics.
  • Postoperative urethral stenosis: This is a narrowing of the urethra that can occur after hypospadias repair, but it is rare. Passing urine may become difficult or impossible. Stenosis requires urgent medical attention.
  • Postoperative fistula: A fistula is a hole that can open up in the newly formed urethra, letting urine leak out. This will require a small surgical repair.

The general consensus within the pediatric urology community is to perform surgery between six and 18 months of age in full-term, healthy infants. This timing is prior to the beginning of gender identification. In cases that are likely to require more than one surgery, your pediatrician or surgeon may recommend starting earlier than 18 months.

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6 Sources
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