Hypospadias is a structural disorder of the penis seen in newborn males at birth. It is a condition that requires active intervention and should be treated to prevent complications related to the structure and functionality of the penis.
Hypospadias may indicate other urogenital complications, such as the absence of one or both kidneys (renal agenesis). It is a condition that does not resolve on its own and must often be corrected surgically, which is usually performed when the baby is aged six months to two years old.
- Most hypospadias types may be treated in a single outpatient procedure.
- Severe cases or certain types of hypospadias should undergo more than one surgery to fix the problem.
- The surgery usually takes one to two hours, although, severe cases may require more than three hours.
- The patient may be sent home on the same day of the surgery.
Mild cases of hypospadias may not require any active procedure.
The newborn with hypospadias must not be circumcised at birth.
What is hypospadias?
Hypospadias is a male birth defect in the position of the meatus (opening) of the urethra in the penis. Usually, the opening is located at the tip of the penis, but in patients with hypospadias, the opening may be:
- present below the penis,
- in the middle of the penis shaft,
- at the base of the penis near the scrotum, or
- even in the scrotum.
If the urethral opening is present under the penis, the structure of the penis may change and the penis curves down. This condition is called chordee.
6 types of hypospadias
Hypospadias is classified into various types based on the position of the urethral opening on the penis, they include:
- The urethral opening is present at the head of the penis where the normal position is at the tip.
- In this type of hypospadias, the penis does not curl during an erection or there won’t be any redirection of the urine stream.
- This is considered the mildest form of hypospadias and is the most common type of hypospadias, which doesn’t require any surgical treatment.
- The entrance of the boy's urethra is placed slightly below the head of the penis in subcoronal hypospadias.
- There may be slight curvature or bending of the penis when it is erected.
- Distal hypospadias occurs when the entrance of the urethra is placed halfway between the border of the head and the center of the side of the penis.
- During an erection, the penis may bend slightly.
- The opening of the urethra is present midway along the shaft of the penis.
- The urethral opening is positioned where the penis meets the scrotum.
- Patients with penoscrotal hypospadias may have a noticeable curvature of the penis during erection.
- Some structural changes of the scrotum can be observed in perineal hypospadias.
- The scrotum is abnormally split, and the urethral opening runs in the middle of the divided sac.
- Surgically, the split of the scrotum is rebuilt so that a single scrotal sac appears normal.
- The penile curvature or bending may be severe but can be rectified.
What are the risk factors of hypospadias?
Hypospadias is usually a genetic disease that runs in the family and is seen in 1 out of every 200 births.
The most important phases in the formation of the penis occur between weeks 9 and 12 of pregnancy. Speculations state if the fetus is exposed to estrogen while in the uterus or exposed to certain drugs that disrupt the endocrine system of the mother, such as digoxin or toxins (such as pesticides), hypospadias may develop.
Some evidence shows that a boy baby delivered to a woman older than 35 years may be at a higher risk of hypospadias. Women who were on hormonal treatment just before or during pregnancy may have higher chances of the condition in their newborns.
Does hypospadias cause infertility?
Adults who have undergone hypospadias surgery may have erectile dysfunction or ejaculatory dysfunction, which may be caused by genital scarring or residual abnormal curvature of the penis.
What are the treatment options for hypospadias?
The treatment options for hypospadias include the following:
The only treatment option to correct hypospadias is a surgery that involves repositioning the urethral opening and rectifying the penis curvature to straighten the shaft.
If the urethral opening is at the base of the penis, grafts from the foreskin or inside of the mouth are used to reconstruct and position the urinary outflow system, thus correcting the hypospadias.
Almost 95 percent of hypospadias surgeries are successful.
Complications followed by surgery
A hole (fistula) may form along the bottom of the penis where the new urinary channel was formed, resulting in urine leakage. There is rarely an issue with wound healing or scarring. These issues may need extra surgery to correct.
There are chances of complications, such as the development of the urethral stricture or curvature issues or worsening of urethroplasties in adults who had hypospadias repair as a child.
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Urology Care Foundation. What is Hypospadias? https://www.urologyhealth.org/urology-a-z/h/hypospadias
Centers for Disease Control and Prevention. Hypospadias. https://www.cdc.gov/ncbddd/birthdefects/hypospadias.html
NYU Langone Hospitals. Types of Hypospadias in Children. https://nyulangone.org/conditions/hypospadias-in-children/types
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