Hypospadias is a birth defect in male infants in which causing the urethra is shortened and the penile opening misplaced. Physicians determine the method of hypospadias repair based on the type of urethral anomaly a patient exhibits. The repair, in some patients, only requires lengthening the urethra, while others require penile reconstruction because of the extent of the malformation. Urologists typically perform hypospadias surgery on an outpatient basis for children aged six to 24 months. Teen and adult males occasionally require surgical repair when prior surgical repairs develop obstructions or other complications.
The urethra is the tube that extends from the bladder to the opening on the end of the penile head. Hypospadias symptoms include urethral openings that occur anywhere from behind the scrotum to the underside of the penile head — location signifying the length of the urethra. Physicians generally find the anomaly at birth, and these infants do not undergo circumcision, as surgeons later use the extra skin for urethral extension. Depending on the severity of the malformation, boys may not have control over the urine stream direction and may later experience fertility problems. The closer the urethral opening develops toward the bladder, the greater the likelihood that the child also has a curved penis.
Under general anesthesia, surgeons begin hypospadias repair by making an incision on the underside of the penis, extending from the glans to the end of the shortened urethra. Using the foreskin, they create a tubal extension and attach the tube to the end of the urethra, after detaching the tissue from the misplaced opening. Surgeons extend the tube through the shaft of the penis to the new opening that has been formed in the glans. Until healing is complete, a catheter is inserted that travels from the bladder and out of the new meatus, or opening. The penis is then taped to the abdomen and the surgical site is protected with a dressing.
Extremely short urethras require not only extension but may also require straightening of the penis. Some patients develop fibrous connective tissue in the penile shaft that causes a constrictive curvature. Surgeons who perform this type of hypospadias repair must first remove this extra tissue. With the penis's angle corrected, surgeons use foreskin or tissue for a graft for urethral extension. Some patients, who have has prior hypospadias repair, may later develop urethral narrowing or obstructions from scar tissue growth, requiring corrective procedures to enlarge the urethral cavity.
Before a hypospadias repair, patients typically undergo physical assessment and examination, to determine the type of surgery required and the general state of their health. Physicians also require medical and medication histories for the child. Pre-surgical instructions typically include food and fluid cessation after midnight on the night before surgery. After a hypospadias repair, children usually receive pain medication and are encouraged to drink fluids for urine formation and elimination. Parents receive instructions for dressing care and information about possible signs of complication.
