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 1 in every 150 to 300 male births with varying degrees of severity. Hypospadias is 21 percent more likely to happen where another close family member has experienced the same defect.

A new born sleeping at the maternity ward
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Hypospadias is corrected surgically under a general anesthetic. The type of surgery depends on the severity of the condition with a variety of repair types. These can be relatively straightforward or can be complex involving urethral reconstruction.

Hypospadias repair purpose is to create a straight penis with opening of urethra in normal position.

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 8 to 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 wound care that will be required postoperatively.

Sometimes a condition known as chordee, a bending of the penis on erection, may also be present, this can be corrected surgically during the operation for hypospadias. Recovery time depends on the severity of the problem and the complexity of the surgery. Mild cases can be treated on an outpatient basis, sometimes inpatient treatment may be required, especially where chordee presents in the same child or untreated adult.

Post-operative Care

  • General anesthetic side effectsAs with any surgical procedure that requires a general anesthetic, side effects can occur. The pre-operative care you or your child receives is an important part of the evaluation of safety and the need for correction of hypospadias. Any possible complications will be explained by your anesthetist, pediatrician or genitor-urinary surgeon prior to the surgical procedure.
  • Postoperative bleeding following repair hypospadias: Any post-operative bleeding should be reported to the surgeon or doctor in charge of post-operative care. Generally, blood on the dressing the size of a small coin can be expected.
  • Postoperative bladder spasm following repair hypospadias: Spasms of the bladder are sometimes experienced when an indwelling catheter is present. The doctor usually treats this with antispasmodic medication, analgesia (painkillers), or sometimes with antibiotics.
  • Infection following repair hypospadias: Infection is a common side effect at the site of the surgery. This can be prevented or minimized by good hygiene of any post-operative 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 following repair hypospadias: This is a narrowing of the urethra that can occur post-surgery but is rare. Passing urine may become difficult or impossible. Stenosis requires urgent medical attention.
  • Postoperative fistula following repair hypospadias: A fistula is a hole that can open up in the newly formed urethra through which urine leaks. This will require a small surgical repair.

The general consensus within the pediatric urology community is to perform surgery between six months and one year of age in full-term, healthy infants. This timing, which is consistent with recommendations from the American Academy of Pediatrics (AAP), allows ample time for completion of a two-stage procedure in patients with severe hypospadias prior to the beginning of gender identification. In general, six months is the minimum time needed between procedures to ensure complete wound healing following the initial surgery.

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  1. American Academy of Pediatrics. Timing of elective surgery on the genitalia of male children with particular reference to the risks, benefits, and psychological effects of surgery and anesthesia. Pediatrics. 1996 Apr;97(4):590-4