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Hypospadias

What is Hypospadias?

Hypospadias is an abnormality of the penis that shows in three separate ways:-

  • The tube (urethra) that carries the urine from the bladder along the penis is not developed properly. This means that the hole through which the urine passes is not at the tip of the penis but can be anywhere from close to the tip of the penis, right down to the middle of the scrotum, as shown in the figure opposite.
  • The foreskin does not properly surround the head of the penis, but is all around the back.
  • The penis may be bent downwards; particularly when stiff (this is called chordee).

How common is hypospadias?

Around 1 in 300 boys in Scotland will have some degree of hypospadias.

How is hypospadias caused?

At the moment we do not know. Most of the boys are completely normal apart from the hypospadias. More rarely the children can have hypospadias together with a number of other problems. There is a very small risk of a brother having hypospadias if one child is affected.

What is chordee?

This is a bending of the penis, particularly when erect. Tight bands of tissue running along the underside of the penis cause it. These bands cannot stretch, so the bend becomes more obvious during an erection.

How can hypospadias be treated?

This depends on the severity of the hypospadias. Mild forms do not necessarily need any treatment but we can offer surgery to make things look better. Your son will need surgery if he has problems standing to pass urine, or if there is spraying of the urinary stream. Also if the penis is bent, there may be problems with sexual activity in the future, unless surgery is carried out.

Is there a right time for surgery?

We usually offer surgery before the child starts school, because we think this is best for your child socially. Also the surgery can be more complicated if left until adulthood.

What is the operation to correct the hypospadias?

There are many operations available. Your surgeon will explain which is best for your child and discuss all the options with you. Most hypospadias can be repaired by one operation with a short hospital stay. Occasionally, however, two operations may be required to give the best result. In the first stage, the penis is straightened by removing the chordee and a piece of skin (skin graft) is taken from the foreskin and placed on the penis. In the second stage (about 6 months later) the opening is moved to the end of the penis and the tip of the penis (glands) is repaired. All operations require a general anaesthetic; many children have a local anaesthetic and medicines to help the pain afterwards.

Will my son be circumcised?

Not necessarily. In some operations the foreskin will be used for a skin graft and to cover the underside of the penis. In a single stage operation it is often possible to recreate the foreskin.

What happens after the operation?

What usually happens is your son will have a tube (catheter) to drain the urine for a few days until the wounds have healed. The stitches are usually dissolvable so do not need to be removed. The catheter is kept in for between 7-12 days, but your child will be able to go home 24-48 hours after surgery with the catheter in, if you and your doctor are happy. The catheter and dressing – if used – will be removed on the ward at the appropriate time. Your surgeon will then arrange to see you back at the outpatient clinic to assess the outcome of your son’s surgery.

What are the risks of hypospadias repair?

All surgery carries a small risk of bleeding during or after the operation and an anaesthetic for any operation carries a very small risk of complications. Specific risks include:

  • Fistula this is a second small hole from which your son will pass urine. If this happens another operation is necessary.
  • Stenosis this is when the new hole tightens down and becomes too narrow. If this happens another operation is needed.
  • Bladder spasm the drainage tube may irritate the bladder and cause pain. A medicine called Oxybutynin can help prevent this.
  • Infection this is rare in hypospadias surgery, but can occur.
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