Hypospadias

Hypospadias is a birth defect in boys in which the opening of the urethra is not located at the tip of the penis. The abnormal opening can be anywhere, from just below the end of the penis to the scrotum. The normal urethra is a tube through which urine flows out of the bladder and passes through the penis. The opening of the urethra (meatus) is normally at the end of the penis, partly covered by the foreskin.

Depending on the site of the opening they are classified as distal (minor type)and proximal (major or severe type).

Hypospadias may also include the following:

• A hooded appearance of the foreskin.
• Tightening of the tissues on the underside of the penis (called 'chordee'). This pulls the penis down and causes bending.This is commonly seen in severe hypospadias.

The further back the opening of the urethra is, the more severe the problems are likely to be:

• Passing urine is different to normal. A baby in nappies will have no problem. However, when older, the urine stream may not be able to be directed forward into a urinal. Chordee causes bending of the penis. This is more noticeable when the penis is erect. Sexual intercourse may be difficult or impossible in severe cases.
• Psychological problems about being 'different' to normal are common.

If the hypospadias is mild, with the opening of the urethra just a little down from normal and with no bending of the penis, no treatment may be needed. However, in most cases an operation is required to correct the hypospadias. This can usually be done in one operation. However, if the hypospadias is more complicated, two operations may be necessary. The operation is usually done when the child is around 12-24 months old.

The aims of treatment are:

• Urine should be passed in a forward way.
• The penis should be straight when erect.
• The penis should look as normal as possible.

This surgery is known as urethroplasty, if chordee is present then this is corrected to straighten the penis. After the surgery a catheter will be inserted in bladder, which will be kept for 8-10 days. The success of the operation and the 'normality' that can be achieved depends on the severity of the hypospadias.The patients are usually kept for 2 days in the hospital. The dressing and tube need to stay in place for 10 days. In small kids the tube will go in double diapers. For about one in ten boys, the original hole opens up again (fistula), so that your son passes urine through two holes. If this happens, your son will need the operation again. The drainage tube can irritate the inside of the bladder, which is painful. This is called 'bladder spasm'. To reduce this, your son will be given bladder spasm medicine along with analgesics.