What is Hypospadias Repair?

Hypospadias repair is surgery to correct a birth defect in boys called hypospadias. This is a condition in which the urethra does not properly exit the penis at the tip.

Effects of Hypospadias Repair

Corrective surgery usually results in a penis that looks normal and functions normally. Surgery can straighten the shaft, position the meatus at the tip of the penis, and remove the hooded foreskin. Patients are able to stand to void, and sexual activity and fertility are satisfactory.

Candidates for Hypospadias Repair

Specific treatment for hypospadias will be determined by your child’s physician based on:

  • your child’s age, overall health, and medical history
  • the extent of the disease
  • your child’s tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference

Your Consultation

Before surgery, testosterone injections or creams may be used to increase penis size and antibiotics are administered to lower the risk for infection. A catheter is inserted into the bladder to drain urine.

The Hypospadias Repair Procedure

Surgical repair of hypospadias is done while the child is unconscious and pain-free (using general anesthesia). The type of repair depends on the severity of the defect. Mild defects may be repaired in a single procedure, while severe defects may require two or more procedures. First, the anatomy is thoroughly assessed. The penile skin is retracted and any curvature is corrected by removing the hardened tissue or pinching (plicating) tissue to offset the curvature. Then, the urethra is extended using local tissue from the foreskin and the opening is repositioned at the tip of the glans. If an adequate amount of tissue is not available, tissue from inside the mouth may be used. Finally, the penile skin is replaced and sutured.

Recovery

After surgery, a tube is left in the reconstructed urethra in all but the simplest cases. This tube is called a “stent,” and its purpose is to allow free flow of urine while the tissues are healing. Often there is significant swelling in the penis, and voiding might be difficult for your child. The tube is most commonly managed simply by allowing it to drain into a diaper. In older children, the tube might be attached to a drainage bag that is emptied periodically. These tubes are usually attached to the head of the penis with one or two stitches, which need to be cut before the tubes can be removed. The tubes might be in place for as few as two or three days, or as long as two weeks. Any change in drainage from these tubes, or in their position, should be reported to your doctor immediately.

Risks

Local swelling and minor bleeding are common following surgery to repair hypospadias and usually are not severe. Antibiotics are continued after the procedure and infection is rare. Complications include adverse reactions to anesthesia and excessive bleeding that may require additional surgery. Long-term complications that may require additional surgery include the following:

  • Development of an abnormal opening from the urethra to the skin (fistula)
  • Narrowing of the urethral opening (meatal stenosis) or the urethra (stricture)
  • Formation of ballooning of the urethra (urethral diverticula)

FAQs

What is hypospadias?

Hypospadias can be a mild defect (with the urethral opening slightly out of place, near the tip of the penis) or severe (with the urethral opening closer to the scrotum). Hypospadias is also frequently associated with a shortening or downward bending of the penis and malformation of the foreskin.

What causes hypospadias?

The cause of hypospadias is not known. The condition results from abnormal development of the urethra in the embryo and not from anything the parents did or did not do during pregnancy. Hypospadias will occasionally occur in more than one male in a family.

What are the symptoms of hypospadias?

The following are the most common symptoms of hypospadias. However, each baby may experience symptoms differently. Symptoms may include:

  • abnormal appearance of foreskin and penis on exam
  • abnormal direction of urine stream
  • the end of the penis may be curved downward

The symptoms of a hypospadias may resemble other conditions or medical problems. Always consult your baby’s physician for a diagnosis.

When is the best time to get treatment?

The best age at which to have corrective surgery depends on the size of the penis and degree of the defect. Repair is usually advised at an early age, unless the patient is not referred until he is older. Health professionals generally recommend repairing genital defects early, so patients can avoid embarrassment that can be associated with the condition.

Why is it necessary to get treatment?

Surgical correction aims to reconstruct a straight penis with a urethral opening as close to the tip of the penis as possible. This will result in a properly directed urinary stream, straightened penis upon erection and an appearance similar to a circumcised penis.