Hypospadias Repair
Hypospadias Repair
Hypospadias repair is a specialized surgical procedure that repositions the urethral opening to the tip of the penis, straightens any curvature, and reconstructs the glans. This treatment is essential for ensuring normal urinary function and proper physical development.
When You Should Consider Hypospadias Repair
Displaced Urethral Opening: When the opening is located on the underside of the shaft rather than the tip.
Penile Curvature (Chordee): A downward bend of the penis that becomes more apparent during an erection.
Abnormal Spraying: Difficulty controlling the urinary stream, often requiring sitting to urinate.
Hooded Foreskin: When the foreskin only covers the top half of the penis, leaving the underside exposed.
Functional Concerns: To ensure future sexual function and to prevent psychological distress related to physical appearance.
How Is Performed
Anesthesia: The surgery is performed under general anesthesia and typically takes one to three hours depending on the complexity.
Penile Degloving: The skin is separated from the shaft to release tethering bands and accurately assess any curvature.
Orthoplasty (Straightening): If a curve is present, the surgeon straightens the shaft, which may involve tucking the topside or using ventral grafting.
Urethroplasty: A new urinary channel is created using the existing urethral plate, local skin flaps, or tissue grafts from the mouth (buccal mucosa).
Glanuloplasty: The new opening is positioned at the tip of the glans, which is then reshaped into a natural conical configuration.
Stent Placement: A temporary urinary catheter or stent is often inserted to keep the new urethra open while tissues heal.
Pre-Procedure Preparation
Medical Evaluation: A pediatric urologist evaluates general health, locates the urethral opening, and assesses the degree of curvature.
Hormonal Stimulation: In some cases, testosterone or HCG may be administered to increase penile size, which can improve surgical success rates.
Fasting: Patients must follow strict "nothing by mouth" (NPO) instructions for several hours before surgery to prevent complications during anesthesia.
Hygiene: Following specific bathing instructions with antiseptic soap as directed by the surgical team.
Tests Before Hypospadias Repair
Physical Examination: To grade the severity of the hypospadias (Glandular, Subglandular, Midshaft, or Penoscrotal).
Ultrasound: Occasionally used to check the rest of the urinary tract (kidneys and bladder) for associated anomalies.
Genetic Testing: May be recommended in very severe cases where the internal reproductive organs need evaluation.
Karyotyping: To confirm chromosomal sex if the physical appearance makes gender assignment unclear at birth.
Life After Hypospadias Repair
Immediate Care: Bandages and compression dressings are applied to minimize swelling; most patients go home the same day.
Catheter Management: The stent usually remains in place for 5 to 14 days. For infants, a "double-diapering" technique is used to keep the site clean.
Medication: Antibiotics are prescribed to prevent infection, and antispasmodics (like oxybutynin) help prevent painful bladder spasms.
Activity Restrictions: Straddle toys, bicycles, and swimming must be avoided for three to four weeks to allow for full healing.
Follow-up: The first appointment typically occurs within one week for dressing and catheter removal.
Why Specialized Treatment Is Highly Effective
Functional Restoration: Corrects the urinary stream to allow for normal standing urination.
Curvature Correction: Ensures the penis is straight, which is vital for comfort and function in adulthood.
High Success Rates: Modern techniques have significantly reduced the risk of complications like fistulas (leaks).
Aesthetic Improvement: Provides a natural appearance that helps prevent future body image concerns.
Minimally Invasive Focus: Most repairs are successfully completed in a single-stage outpatient procedure.