The following questions should help you speak to your son’s hypospadiologist (Surgeon).

Hypospadias is abnormal position of urethral opening on the under surface of the penis with the deficient foreskin ventrally and excessive skin dorsally known as dorsal hooded prepuce. Ventral curvature of penis may present.
In a normal penis, the urethra has two functions.
1- Pathway for urine from bladder to tip of glans penis.
2- Also provide pathway to semen so during sexual life semen should enter to vagina. In hypospadias penis both these function hampered because urethral opening is not present at tip of penis.
Hypospadias is the most common congenital defect of the penis, occurring roughly 1 in 250 male children. It is rare in female.
Hypospadias prevents patients from urinating whilst standing up due to spraying and poor stream. Chordee may impair sexual function. This may lead to psycho-sexual problems and poor quality of life. Surgical repair is necessary.
Genetic factors are likely to involved in some cases. The probability – 7 – 8% have affected fathers, and 12 – 14% have affected brothers. If both father and brother are affected, the risk in a second boy increases to 21%.
Surgery is safe under general anesthesia given by specialized anesthesiologist with caudal block, provided general condition is healthy. Caudal nerve blocks minimize pain and discomfort when the child recovers after the operation.
Surgeons have been correcting hypospadias with surgery for last more than two centuries. More than 400 operations have been described, but nowadays only a few of techniques have been used by hypospadiologist, as the modern techniques of hypospadias reconstruction began in the 1980s. The aim is to create a normal straight penis with a urethral opening at the tip of the glans penis with either circumcising or reconstructing the foreskin. Hypospadias repair is usually finished by one hour for distal hypospadias to two-hour or more for proximal hypospadias. In a few cases, however, it is done as stages procedure. Some time, application of the testosterone ointment is required prior to surgery for proximal hypospadias.
The procedure will depend on a number of factors, including the degree of hypospadias and extent of penile curvature. Final decision will be taken on the operation table; it may be possible that for distal hypospadias may turn out, in to a more complex problem. As we are familiar with different techniques so we’ll take decision as per situation.
Immediately after hypospadias repair wounds do not require special attention. Your child will have bandage and urine will drain through urinary catheter to urine beg. You will receive specific instructions regarding bandages and routine bathing after discharge. Catheters are usually kept in place for seven to ten days.
Wound healing after a hypospadias repair usually begins early, and lasts for many months.
Because it is difficult to predict problems later in life, it is recommended routine correction, regardless of the severity. Reason is urethral opening may be in a nearly correct position, but it is mostly stenosed leading narrowing of urinary stream and spraying, so soiling of cloths may happen.
Modern hypospadias surgery creates a normal good functioning penis which looks normal or nearly normal. The complication rate is less than 10 percent. Problems may occur more often after a proximal hypospadias repair.
Early complications which may occur as in all surgical procedures, including inflammation, infection, wound healing problems, bleeding during and after surgery, bruising, wound dehiscence, flap or graft necrosis, urinary tract infection and alteration of sensation or scarring. Late complications such as – • Urethral fistula (5-12%) • stricture urethra (that is due to Scar narrowing of urethra) • Recurrence of penile curvature Urethral stenosis • Local site Scar formation. The complications rate is mostly dependent on the severity of hypospadias, the age of patient, and the quality of the surrounding local tissue for the reconstruction, and the number of previous interventions.
Yes. It is unfortunate that few children require re-operation because of complications or due to inadequate local tissue or may be related to poor healing. Fortunately, the majority of operations are successful at first time because good technique, more advance developed instruments. If redo or second time surgery require, most of them will have a good outcome. “Hypospadias cripples,” is describe the patient who has under gone multiple, unsuccessful hypospadias repair attempts with significant resultant penile deformity. ypospadias cripples require even more complicated stage procedure / surgery.
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