Hypospadias

Definition

Hypospadias is a congenital condition affecting the penis where the urethral opening is not located at the tip but somewhere along the underside of the penis.

Hypospadias is quite common, and is increasing.

It occurs in about 1/250-1/300 boys. It is more common with IVF babies.

With a family history, the risk is increased.

The chance of having a second child with hypospadias, is about 1/30 (14% of male siblings).

Signs and Symptoms

• Urethral Opening Location: The opening is not at the tip of the penis but along the shaft.
• Foreskin: The foreskin may be incomplete, often forming a “dorsal hood” over the top of the penis.
• Chordee: The penis may be curved downward (chordee).
• Urinary Stream: The urine stream may not be straight.

Associated Conditions

• Undescended Testicles: Hypospadias can be associated with undescended testes.

Treatment

• Surgical Correction:
  • Objectives: Move the urethral opening to the tip of the penis, straighten the penis, and achieve a normal appearance.
  • Timing: Typically performed between 6 and 18 months of age.
  • Pre-Surgery: Circumcision should be avoided as the foreskin may be needed for the repair.
• Types of Surgery:
  • Urethroplasty: Creation of a new urethral channel.
  • Chordee Correction: Straightening of the penis.
  • Multiple Surgeries: More than one operation may be needed.

Risks and Side Effects of Surgery

• Catheter or Stent Use: May be required for about a week to help with urine drainage.
  • Bladder Spasms: Medications can manage these if they occur.
• Bleeding: Some bleeding from the penis is common post-surgery.
• Wound Healing Issues: There may be a risk of wound breakdown and fistula formation (urine leakage).
• Stricture: The new urethral opening might narrow, making urination difficult.
• Incomplete Correction: The penile curvature might not be fully corrected.

Post-Surgical Care in Hospital

• IV Therapy: For fluids and medications until the child can eat and drink.
• Antibiotics: To prevent infection, given through the IV and then orally at home if needed.
• Pain Management: Regular pain relief will be administered.
• Dressing: May be placed around the penis and will be removed based on the doctor’s instructions.
• Hospital Stay Duration: Depends on the severity of the condition, recovery speed, and caregiver comfort with managing the catheter at home.

Post-Surgical Care at Home

• Preventing Adhesions: Use Vaseline to prevent the penis from sticking to nappies or clothing.
• Fluid Intake: Encourage plenty of fluids to ensure frequent urination.
• Pain Relief: Use paracetamol or other prescribed pain medications.
• Oral Antibiotics: Administer as instructed to prevent infection.
• Dressing Care: Follow doctor’s instructions on when to remove or soak off the dressing.
• Activity Restrictions: Avoid vigorous activities until cleared by the doctor.
• Bathing: Add two tablespoons of cooking salt to bathwater to reduce swelling when baths are allowed.

Key Points

• Hypospadias: A congenital abnormality of the penis where the urethral opening is misplaced.
• Surgery: Usually required unless the condition is very mild.
• Experienced Surgeon: Surgery should be performed by an experienced paediatric urologist.
• Post-Op Care: Includes managing a catheter, monitoring for complications, and ensuring proper healing.