Hypospadias is a birth defect of the penis that occurs in about three out of 1,000 boys. Most of the time the cause is not known, although the problem can run in families. It can be recognized easily after birth because the urinary opening is on the underside rather than at the tip of the penis. Usually the foreskin is only fully formed on the top of the penis, which is often bent down (chordee). In most cases, circumcision will not be done because the foreskin may be needed to repair the hypospadias during surgery.
When left untreated, severe forms of hypospadias can prevent a man from having sex or fathering children. This is mostly because the penis bends downward abnormally with erections, but men with uncorrected hypospadias may also be self-conscious about the appearance of the penis. In addition, the abnormal location of the urethral opening may make it difficult to urinate in a straight stream while standing. The unusual appearance of the penis may lead to embarrassment.
Surgery for Hypospadias
Surgery is required to repair hypospadias. It is best to wait until your child is about six months old to have surgery. At this age, the anesthetic risks are low and the psychological stress of the surgery is minimal.
The goals of hypospadias surgery are to straighten the penis, move the urethral opening to the tip of the penis and remove excess foreskin. The surgeon will make every effort to make the penis look completely normal. Depending on the severity of the defect, the operation can take between one and four hours, with general anesthesia. In some boys, more than one operation may be needed to fully correct the problem. In some cases, testosterone, a male hormone, is recommended prior to the surgery to help the penis grow, which can make the surgery easier.
Your child will usually be ready to go home about one hour after surgery. He will receive numbing and pain medicine during surgery, and can be given acetominophen and ibuprofen as needed afterward. An antibiotic might be prescribed to prevent bladder spasms. He will be able to eat and drink right away. Your child may be sent home with a tube in the penis which simply drains into a diaper. The penis will be wrapped with a dressing that may come off by itself or be removed on the second day after surgery. The tube is removed in the the doctor's office approximately one week after surgery. Immersion in water should not take place until the tube is removed.
Your child should be kept off riding toys and strenuous exercise for about two weeks after the surgery. He will usually see the doctor again for a post-operative visit at two weeks, by which time the stitches have usually dissolved.
Potential Complications from Surgery
Bleeding and infection are possible but rare. The most common complication is a fistula, or hole, on the shaft of the penis. This may require a second surgery about six months later. There may also be scarring of the new urethra, which may require further surgery.
When to Call the Doctor
After surgery, call the doctor if your child has pain that cannot be controlled by medicine, or high fever, severe swelling or drainage from the incision. Mild swelling and bruising are normal, and low-grade fever (less than 101.5 degrees) is common. If there is a tube in place, your child may feel the urge to urinate, but the tube will drain constantly. However, never hesitate to call your physician if you have any concerns or questions.
What to Expect as Your Child Grows
After surgery, your doctor may want to check the penis and urinary stream from time to time. Infections, strictures or fistulas can develop months or even years after hypospadias repair, although this is rare.
Pediatric Urology at Cedars-Sinai
Children are affected by different urologic conditions than adults, and their smaller bodies respond differently to anesthesia and surgical incisions. For these reasons, the Cedars-Sinai Urology Academic Practice is guided by the philosophy that pediatric patients are best evaluated and treated by pediatric specialists. Andrew Freedman, MD and Barry Duel, MD, the Urology Academic Practice's pediatric urologists, devote their practice to the evaluation and treatment of children. Both are board certified in Pediatric Urology, and offer broad experience in minimally invasive laparoscopic procedures. Dr. Barry Duel is experienced in robotic procedures adapted for the needs of children. The majority of their procedures are conducted on an outpatient basis, with both outpatient and inpatient surgeries attended by specialized pediatric anesthesiologists.