Hypospadius

By Philip E. Gleason, MD

 

Hypospadias is a developmental abnormality in which the opening of the urethra does not reach the glans, or head, of the penis. Rather, it opens along the undersurface of the penile shaft. It occurs in about 1 in 300 boys. It does tend to be slightly more common in families in which the father or uncles or other brothers have had hypospadias. Fortunately, it typically represents only an abnormality of the penile development of the urethra. The urinary tract including the bladder and kidneys are typically normal. The reproductive tract including the prostate, testicles, and future considerations of fertility are usually normal. As a rule of thumb, we allow the children to void into their diapers during the first 9-12 months of life. Consideration of repair is then given at approximately 9-18 months of life.

 

The decision to proceed with repair typically includes both medical and cosmetic considerations. From a medical standpoint, the penis provides two predominant functions. First, it allows boys to stand to void and direct the urine stream. Second, at allows impregnation by depositing sperm in the vagina during future intercourse. If the opening of the urethral meatus is far enough along the penis so that these are possible, then it is sometimes elected not to pursue any further correction. If, however, the opening of the urethra is more proximal toward the base of the penis, then it will be difficult for children down the road and we would want to give consideration to repair. Further, sometimes regardless of where the opening of the urethra is, there is an associated bending or curvature of the penis. This can make it difficult with future erections and intercourse. Again, that would be an indication to consider future correction and repair. From a cosmetic standpoint, again the opening of the urethra tends to guide us. If the opening is along the tip of the penis and overall appears fairly normal, then there is no requirement for correction. If, however, the opening is along the base of the penis or if there is an abnormal cosmetic appearance to the foreskin or the glans (or head) of the penis, etc., then that would be consideration for repair.

 

Technical aspects of hypospadias repair are quite variable. Sometimes repairs can be quite minor, requiring only an hour or so of operating time and relatively minor surgery. Other times, the repair is quite involved with many technical components. These repairs may require three to four hours of correction with the need for urinary diversion or drainage of urine post op while the penis heals. It is oftentimes difficult to tell precisely prior to surgery what type of repair will be required, as this is sometimes changed with findings at that time of surgery. For the most part, though, the repairs typically do very well and do not have any particular complications. Possible complications include development of a hole from the urethra to the skin, usually where a suture was placed to elongate the urethra. This is called a urethrocutaneous fistula. This will oftentimes close on its own. If it does not then it may require a minor out patient surgery to correct that 6-12 months after the initial hypospadias repair. Another potential problem is stricture, or scar formation, of the urethra where it has been corrected. Fortunately, this is rare.

 

I hope this will provide some information to you. The self-guided lecture includes a picture of the penis with various degrees of hypospadias formation.

 

 

© 2005-2010, Dr. Philip E. Gleason, MD