HYPOSPADIAS

Little baby boys pass urine like a fountain. Small lads can stand and pass urine straight with an ability to point the stream where they want, like a fire-man’s hose. This is possible because the urine comes out of the opening at the tip of the penis. In boys with hypospadias, the opening is located on the under surface of penis. Because of this the urine is deviated downwards towards their feet.

How is hypospadias detected?

Hypospadias occurs in one in 300 male newborns. When the paediatrician checks out the baby, or when the parents bath the baby, the following features are there-

• Abnormal spraying of urine
• Penis being slightly bent downwards
• Having to sit down to urinate
• Malformed foreskin that makes the penis look "hooded"
• Urethra opening on the underside of the penis
• What are the consequences of Hypospadias?

When hypospadias is left uncorrected, the following consequences can develop

Hypospadiac lads have to sit; if they stand and pass urine, it goes down the leg.
When they get older, sexual activities become difficult.
Sometimes the urinary opening is also small, leading to blockage in urine stream. This leaves them at a risk of urinary infection.

Do they have other birth defects? Can the same problem recur in future children?

In general, hypospadiac children do not have other kidney abnormalities. However in 10% of these kids, the testis may not be descended normally. When the first child or the father has hypospadias, there is a slightly higher chance (7-10%) for the future boys in the family to have the same birth defect.

What is the right time to correct hypospadias?

From 6 months onwards, hypospadias can be corrected by an operation. Not having an appearance like other boys at school, can lead to emotional problems in these children.

What does the operation involve? What are the complications?

Most of the hypospadias can be operated by a single stage operation. When the opening is too far down from the tip, they might require two-stage operation. The operation is usually done under general anesthesia and a catheter/ dressing is left for 5-7 days. Three things are corrected during the operation.

• The opening is brought to the tip
• The penis is straightened
• Excess foreskin is removed (circumcision).
• Optical magnification (microscope) and fine suture materials are essential for a successful result. When extra care is taken there is a very good (95%) success rate. In 5% the following complications can occur.

The new opening gets small gradually (meatal stenosis)
Urine leaks at the original site (Fistula)
Both these can be corrected by another minor operation; so the parents need not have undue concern about this.

What are the chances of fertility after operation?

Straight penis and an opening at the tip are essential for a successful married life and fertility. When the problem is corrected by 1-3 years of age with a good outcome, there should be no problem in future for fertility.

Key Points:

1. In children with hypospadias, the opening is on the under surface of penis.
2. Because of this, these lads can’t stand and pass urine like normal children.
3. They can have infertility in later life, if left uncorrected.
4. By performing a corrective surgery at the right age, these can be avoided.