Hypospadias : A Defect in Male Births - Health Education - DesiMD Healthcare - India

Hypospadias : A Defect in Male Births

Dr.Surya Rao Poodipeddi profile Authored by Dr.Surya Rao Poodipeddi on 4 Nov 2014 - 13:20.

Hypospadias is present only in male babies. Hypospadias is a common birth defect occurring in about every one of 250 male births. In babies born with a normal penis the urine passes from an opening sited at the tip of the penis. However, babies born with hypospadias will have the opening for the passage of urine somewhere on the undersurface of the shaft of the penis.

Hypospadias doesn’t present itself in a uniform position. It has different degrees of presentation. Those with minor degree will have the opening very close to the tip though not exactly at the tip. In severe cases of hypospadias the opening is almost close to the scrotum and in some cases it may even divide it.

This abnormality may present with three components:  

  • The opening is always away from the tip.
  • The penis may be curved downward a phenomenon called chordee and this deformity becomes prominently evident during erection. The more severe the hypospadias the more prominent will be the chordee
  • When the penis is viewed sideways the undersurface gives the appearance of a hood because there is always deficiency of the prepuce (the flap of skin which covers the glans penis) on the undersurface.

This condition is associated with several problems:

  • Instead of the normal passage of urine directed forwards, the flow of urine in children with hypospadia is deflected towards the feet soiling the clothes of these babies, which embarrasses a child of school going age.
  • Though not of immediate concern, children with this defect face problems in sex act, as they grow older if the defect is not addressed through surgical correction.

Though surgical correction can be done at a convenient time, ideally the correction must be completed before the child goes to school. The exact timing for operation vests solely on the recommendations of the pediatric surgeon whose decision is based on several considerations. The operation is done in 2 stages at an interval of 6 months between the stages. Ideally the first stage of operation is preferred when the child is one year old.

The operation is always done under general anesthesia and normally takes 1 to 1 ½ hours if done by an experienced pediatric surgeon in a hospital with all the required facilities. Blood transfusion is never required during the surgery. In order to avoid soiling of the dressings over the operated and bandaged area an indwelling catheter (catheter which stays in the bladder) is inserted into his urinary bladder, which remains in for about 6 to 7 days after which it is removed. This helps proper drainage of the urine from the bladder.

The surgery involves expert handling where the surgeon uses the redundant foreskin to reconstruct a tube from the existing opening to the tip of the penis. Improved modern techniques make it possible to perform the operation in a single stage thereby reducing hospital stay and expenses. However, needless to mention these modern techniques are more demanding.

It is absolutely essential that a competent and experienced pediatric surgeon perform the operation with extensive knowledge in reconstructive surgery, which the procedure demands.

In spite of all the care taken by the experienced surgeon chances are that a child may have some postoperative complications and such problems can be expected in 10 to 15% of the patients.

The common problems that can be encountered are:

  • There may be some bleeding into the dressing or the urine tube, which is not uncommon. However this is a temporary problem.
  • Infection is prevented with use of appropriate antibiotics both before and after surgery. However, if infection prevails damage of the reconstructed tube may take place leading to its breakdown. Because of the continued presence of the catheter in the urinary bladder the child may experience bladder spasms. Giving him severe pain.
  • Also the child may experience pain if there is erection of the penis when the bandage is still in place. Medicines can only reduce the intensity of pain but cannot alter the occurrence of spasms.
  • In some children there may be leakage of urine into the dressing as the child strains to pass stools. However, there is no cause for major worry in this regard.
  • Urinary fistula is another complication that might occur after surgery and the child may pass urine from more than one place The more the severity of hypospadias the more the chances for this type of complication. However, the fistula can easily be repaired during the second stage of operation.
  • In cases with severe chordee there may be residual chordee after surgery and a curvature up to 10 degrees may be acceptable since this defect doesn’t lead to any functional disability.
  • In rare cases, the child may have stricture in the urethra leading to difficulty in passing urine. However, this can be rectified through dilatation (stretching) for some time.

Though this defect is not uncommon, this brief description of the problem should help mothers with a better understanding of the condition, if she finds her newborn baby with hypospadias.

*Disclaimer
*Disclaimer: This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.