Treatments
- Treatment for hypospadias depends on the type of defect the boy has. Most cases of hypospadias will need surgery to correct the defect. Surgery has basically two goals:
- To move the hole (urethral opening) to the tip of the penis, and close over the hole that was previously there – this will enable your child to urinate standing up and with a straight stream of urine
- To correct the bend so that the penis is straight and make the penis look normal.
If surgery is needed, it is usually done when the boy is between the ages of 3–18 months old. In some cases, the surgery is done in stages. Some of the repairs done during the surgery might include placing the opening of the urethra in the right place, correcting the curve in the penis, and repairing the skin around the opening of the urethra. Because the doctor might need to use the foreskin to make some of the repairs, a baby boy with hypospadias should not be circumcised.
Surgical Options
There is more than one way to repair hypospadias. For distal hypospadias, the most commonly used operation around the world is called TIP (tubularized incised plate). E prefer this method in most of our cases. Options for proximal hypospadias repair depend, in large part, on whether the penis is curved. If it is not, then the TIP and onlay foreskin flap repairs are the two most commonly used procedures. When the penis is bent, we recommend a two-stage repair. In the first operation the penis is straightened, and the urine channel is repaired in a second operation six months later. These two-stage operations use foreskin flaps or grafts, which are not the same and have different results.
All these operations can be done as “day surgery,” meaning that your child can go home the same day as the operation.
The Best Age for Surgery
In general, distal hypospadias repair can be done safely in a full-term infant who is otherwise healthy any time after three months of age. Proximal repairs are often scheduled at six months or later.
Although it is not clear if the child’s age influences the results of surgery, it is likely that older children will have more fear going to the hospital and having an operation.
They are also more likely to have memories of the experience than if they have surgery as an infant.
Anesthesia and Postoperative Pain Treatment
Hypospadias operations are all done with general anesthesia, meaning the child is unconscious.
Caregivers often express concern about the pain their son will have after surgery. Fortunately, the pain is usually less than they expect, especially when the operation is done on infants and young children. Teens and adults feel more pain, which is generally true of any operation; younger children seem to recover faster with less pain than do teens and adults. The catheter that most patients have after surgery also causes discomfort (so-called “bladder spasms”). Erections in teens and adults may also cause discomfort. No medication can prevent these erections.
The most common complication of hypospadias repair is fistula, a hole that develops along the underside of the penis where the new urinary channel was created and results in urine leakage. Rarely, there is a problem with wound healing or scarring. These complications may require an additional surgery for repair.
