Hypospadias is a common congenital medical condition that affects the penis of 90% of males.
The formation of the penis might get affected by an imbalance in hormones in the first trimester of pregnancy. However, not all cases of hypospadias occur congenitally as the condition can also arise in patients following surgical repair of the penile shaft.
To learn how hypospadias might affect the functionality of the penis, we need you to, at first, understand how the penis works.
What is Hypospadias?
The penis comprises of a long tube or the urethra that is responsible for carrying the urine and semen towards the outside through an opening at the tip of the penis called the ‘meatus.’
In hypospadias, however, the urethral opening is situated ventrally and proximally along the shaft. As the meatal opening is situated along the underside of the shaft of the penis, it might create a thin or double urinary stream.
One important thing to note, though, the higher the ectopic position of the urethral meatus, the more difficult it will be for the patient to void while standing up. As the urinary stream will most likely be directed downwards, voiding in a seated position might be mandatory for the patient to avoid discomfort and difficulty in micturition.
At times, the shaft of the penis might deflect downwards or upwards, giving rise to a curvature known as chordee, which can result in a deflected urinary stream and ejaculate as well.
A deflected curvature of the shaft can also make coitus difficult, resulting in painful erection and inability to engage in vaginal intercourse.
Hypospadias surgery from infants to adults differs in the prognosis rates as it might be challenging but still has a 95% success rate. Surgical repair of hypospadias takes place as per the position of the meatus and the progression of the symptoms.
Treatment and Surgical Repair
Most commonly, hypospadias comes into notice right after birth or in religious communities where newborn circumcision is considered a priority.
Since the foreskin is also incompletely formed along with the ventral and proximal position of the meatus, this brings the parents’ attention to the condition. Hypospadias reconstruction has been relevant since the 1800s, giving rise to 200 different types of surgical interventions for the treatment of the condition.
As mentioned before, the severity of the condition highly correlates with the decision to consider surgical repair or not. As the occurrence rate of hypospadias is relevant with 1 in 125 living males, the severity can put into motion as the signs and symptoms can become more severe after puberty.
However, when diagnosed in young infants, most urologists consider counseling the parents so that they can opt for surgery and get their child treated without further delay. As age progresses, most pediatric urologists usually consider getting a psychological assessment of the patient to conclude the degree of emotional trauma suffered on account of the physical deformity.
Usually, most pediatric urologists perform meatal dilatation if the infant’s hypospadias is associated with premature meatal stenosis, also known as indefinite closure of the urethral opening. The meatal dilatation also helps to expand the urethra so that the urinary stream can flow in a healthy stream without being deflected or compromised.
However, there are a lot of other physical factors that urologists consider before opting for surgery. For instance, the position of the meatal opening is vital along with the size of the penis, not to mention the corresponding milestones of development.
In addition, it is also necessary to consider the child’s health, including his tolerance to surgery and the chances and types of complications that might arise if hypospadias reconstruction is done.
In some cases, the rate of complications is so high with the type of hypospadias repair that the parents are counseled for daily life adjustments and the surgery is put off until further intervention is required.
According to The American Academy of Pediatrics Reviews, the ideal age for hypospadias surgical repair including other forms of genital surgery is from 6 to 12 months of age.
As the infant’s penile length is only 0.8cm shorter than what it would be by the time he is 3 – 4 years of age, surgery with optimal anesthesia can be planned out optimally. However, many urologists tend to consider a younger age of 4 months ideal for surgical repair of hypospadias mainly due to the optimal size of the phallus in addition to fewer surgical risks and higher tolerance rates.
As age progresses to 18 months of age, the child also starts undergoing toilet training. Most urologists prefer doing surgery at the age of 18 months of age as the child is fully aware of his genitalia and can, therefore, withstand surgery.
As a parent to a child who has undergone hypospadias reconstruction with or without meatal dilatation, it is necessary to note that avoiding catheter might be inserted into the urethra for 5 to 14 days post-surgery. If your child is still not toilet trained, then the catheter might lead to a diaper, or in most cases, a bag for assessing the volume voided.
As a result of the catheter in situ, the child might report of burning or pain per-urethra or bladder spasms. Usually, urine culture for sensitivity is sent when the catheter is removed in the first 5 or 14 days so that any infection can be treated accordingly.
The urologist will either prescribe antibiotics if the culture is positive as per sensitivity and painkillers and antispasmodics for treating spasms. If the surgery fails, further surgical repair or reconstruction of the penile shaft can only take place or will be advised after 6 months following the first intervention.
Following hypospadias repair, the penile shaft can become a host of minor to major complications. For instance, the corrected meatal opening can either become too narrow (meatal stenosis) following surgery or heal irregularly with local scarring of the urethra.
This condition is known as urethral stricture in which the patient might experience hesitancy, difficulty, and pain upon urination. As per the location of the urethral stricture, further decision to undergo regular urethroscopy with urethral dilatation, timed self-catheterization or surgical intervention (urethroplasty) might be advised.
In later stages of life, some patients report of the occurrence of a urethrocutaneous fistula, where an irregular opening or hole arises near the skin of the scrotum. Upon micturition, the hole can become a passage for leakage of urine, giving rise to urine incontinence or dribbling of urine after urination. Recurrent hypospadias or chordee can also arise in attempted surgeries along with swelling or torsion of testicles.