Pediatric Urological Surgery

Hypospadias

What are the characteristics of hypospadias?

1. Abnormal appearance of the glans penis.
2. Premature opening of urethra.
3. Incomplete foreskin ("Dorsal-hood" prepuce).
4. Curvature of penis (ventral chordee).

How common is this condition?

This is second only to undescended testes as a congenital abnormality affecting a boy's genitalia. It occurs in 0.3 of the male population. There is a familial tendency towards hypospadias with an increased incidence noted in boys whose father or brothers have hypospadias
(8-14%).

What problems may result from hypospadias?

1. Sexual function is usually affected only in those with significant penile chordee that may interfere with future intercourse and potential fertility.
2. Deflection or spraying of the urinary stream is common, making it difficult to urinate accurately when standing.
3. Cosmetic/psychological considerations: the unusual appearance of the penis may affect interactions with other children (teasing, embarrassment) and later on affect an individual's sexual development.

Classification of hypospadias

A useful means of classification emphasizes the position of the urethral meatus (opening), which may be modified at the time of surgery if there is penile chordee (curvature) to correct. Correction of this curvature usually results in increasing the distance between the urethral meatus and tip of the penis.

Position Incidence Curvature Anterior 70 Minimal Middle 20 Moderate Posterior 10 Severe

Plan of Treatment

Surgical correction aims to reconstruct a straight penis with a urethral opening as close to the top of the penis as possible. This will result in a properly directed urinary stream and normal sexual capability, with an appearance similar to a circumcised penis. The surgery is performed under general anesthesia, and most often your child will be admitted and discharged from the hospital on the same day. In the more complicated hypospadias repairs (about 30) a catheter will be left in the bladder to drain the urine for 1-2 weeks. The surgery requires anywhere from 1-4 hours depending on the severity of the hypospadias deformity. The ideal time to perform hypospadias surgery is between 6-15 months of age, when the psychological effects of genital surgery and parental separation are still minimal.

Post-operative Instructions

1. Your child will usually be discharged from the hospital on the same day of his surgery. An overnight stay can be arranged if the child or parents would be made more comfortable.
2. Most children will not have a catheter, and may complain of discomfort (cry) while voiding through the repaired area for a couple of days.
3. A catheter is necessary in less than 30 of all my hypospadias repairs. If your child should require a catheter, it will simply drip urine into his diaper.
4. Sponge-bathe your child for the first 48 hours following surgery, then resume regular bathing. When a catheter is used, do not resume regular bathing until I have removed the catheter and penile dressing.
5. Older children should avoid strenuous activities (fighting, gymnastics) for 2 weeks. There is no need to restrict the activities of infants, except for swimming.
6. Feel free to call the pediatric urologist if you are concerned with your child's progress after surgery (temp. 101°R, bleeding, extreme irritability, or difficulty urinating).
7. Please call the pediatric urologist for an appointment 1-2 weeks following his surgery.

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