Treatment for Male Hypospadias

For a variety of reasons doctors prefer to do hypospadias surgery in full-term and otherwise healthy boys, between the ages of three and 18 months. Yet the repair can be corrected at any age in childhood and even into adulthood. Occasionally, when the opening is proximal, treatment with the male hormone testosterone prior to surgery may be recommended.

The goal of the surgery is to create a normal straight penis with a urinary channel that ends at the tip of the head of the penis. The operation usually involves four steps: straightening the shaft; creating the urinary channel; positioning the urethral opening in the head and either circumcising or reconstructing the foreskin.

Hypospadias repair is usually accomplished in a ninety-minute (distal) to three-hour (proximal) same-day surgery. In a few instances, however, it is done in stages, usually when a paediatric urologist wants to separately straighten the shaft before constructing the urinary channel. It can be done under general anaesthesia or spinal anaesthesia.

First degree hypospadias are primarily a cosmetic defect and have little effect on function except for direction of the urinary stream. If uncorrected, a second or third degree hypospadias can make urination messy, necessitate that it be performed sitting, impair delivery of semen into the vagina (possibly creating problems with fertility), or interfere with erections. In developed countries, most hypospadias are surgically repaired in infancy. Surgical repair of first and second degree hypospadias is nearly always successful in one procedure, usually performed in the first year of life by a pediatric urologist or a plastic surgeon.

If the penis is small, testosterone or human chorionic gonadotropin (hCG) injections may be given to enlarge it before surgery. Surgical repair of severe hypospadias may require multiple procedures and mucosal grafting. Circumcision should be avoided before repair.

Many surgeons prefer that their patient not urinate through the fresh repair during the first few days after surgery. So they leave a small catheter in the penis that drains into the diaper. Antibiotics, and sometimes bladder antispasmodics, are given while the catheter is in use.

Follow up visit schedule depends on the urologist. Complications like pain, bleeding and opening of sutures can be seen after the surgery.

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