Hypospadias is a common congenital condition where there is incomplete closure of the urethra, resulting in misplacement of the urethral opening. In recent times, there has been an increase in the number of boys affected by hypospadias. Different studies have reported varying figures, ranging from 1 in 200 male births to 1 in 350 male births, with an average of about 1 in 300 boys having this condition. Children with hypospadias are classified into different groups based on the location of the urethral opening along the penis. As the location moves further away from the tip of the penis, the complexity of hypospadias increases.
Types of Hypospadias
- Anterior Defect: This is located near the tip of the penis, towards the distal end of the glans. Approximately half of all cases fall into this category. Correction of this type is generally simpler, and sometimes correction might not even be necessary if the opening allows normal urine flow without problems.
- Midshaft Defect: This extends from the scrotum to the middle portion of the penis. Around 20% of cases are of this type.
- Posterior Defect: This occurs from the base of the scrotum to the perineal raphe (lower part of the scrotum). About 30% of cases fall into this category. Correcting this type of defect is challenging, and satisfactory outcomes are achieved after the first surgery in only about 50% of cases. Additional surgeries are often required for optimal results.
Boys with hypospadias may also experience changes in the formation of the foreskin, the tissue that surrounds the penis. Hypospadias prevents the proper development of the foreskin, leading to its formation only in the upper part of the penis and not in the lower part. This might result in the penis resembling an uncircumcised penis after circumcision.
Treatment
Treatment for hypospadias is typically surgical. While in the past, surgeries were often performed at a relatively older age (around 3 years old), due to psychological and emotional challenges and the difficulties of genital surgery at a later age, corrective surgeries are now usually performed between 6 and 12 months of age.
In most cases, a single surgery corrects the defect and improves the aesthetic and functional shape of the penis. The majority of surgeries result in good urinary and sexual function after the procedure, without fertility issues.
Complications
Apart from the general surgical complications like infection and wound leakage, there are specific complications associated with hypospadias repair. One common complication is a urethral fistula or stricture, which involves urine leakage at the suture site of the newly reconstructed urethra. This requires additional surgery to address the leakage and ensure proper urine flow through the reconstructed opening. In rare cases, the repair might need to be redone if complications arise.