Definition Hypospadias a condition in which the opening of the urethra is on the underside of the penis, rather than in its normal location at the tip of the penis. About half the time, the opening is within an inch of the penis tip. This is known as anterior hypospadias. However, the opening can fall anywhere along the shaft of the penis to below the base of the scrotum. This condition is present from birth.
Who is a candidate for the procedure? Anyone with this condition is a candidate for surgery, since the problem cannot be treated any other way. When the urethral opening is located at the base of the head of the penis, it does not interfere with the normal functions of the penis. However, the problem is often corrected to avoid psychological problems that can come from an abnormal appearance of the penis. The procedure is usually done on children between the ages of 6 and 18 months. Surgery on infants under 6 months carries a higher risk from anaesthesia.
How is the procedure performed? The surgery is usually performed under general anaesthesia, which means that the child is put to sleep with medications. There are many techniques for hypospadias repair. Newer methods accomplish the repair in one stage. The repair procedure is fairly simple when the opening is near the head of the penis. The operation is more complex when the urethral opening is along the penile shaft. In these cases, tissue flaps or skin grafts may need to be transplanted from other sites. A urinary catheter, or a narrow tube called a stent, is put in place for a short period of time to keep the urethra opened
What happens right after the procedure? After the surgery, the child will be taken to the surgery recovery room to be monitored for a short time. Vital signs, blood pressure, pulse, and breathing will be checked frequently. Medications may be given to relieve pain. The child is encouraged to drink plenty of fluids to maintain an adequate urine output. Most repairs are performed in a same day surgery centre, and the child can go home after recovering from the anaesthesia. In some cases, an overnight hospital stay is needed.
What happens later at home? The amount of home care a child needs will depend on the complexity of the operation. Caring for the wound itself is straightforward. However, there may be a catheter in place when the child goes home. The parents will be shown how to care for the catheter until it is removed during a follow up visit with the surgeon.
What are the potential complications after the procedure? There are complications with any surgery or anaesthesia. These include bleeding, infection, and reactions to the anaesthesia drugs. The penis may swell for a few days after surgery. The most common long-term complication is leakage of urine from a small hole where the skin was stitched together. This known as a urethrocutaneous fistula. The problem occurs in about 5 to 10% of hypospadias repair operations.
Author: Stuart Wolf, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
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