Hypospadias is a congenital condition. In hypospadias, the urethra’s opening is displaced from the penis glans to anywhere, ranging from the penis shaft to the scrotum. Mild cases of hypospadias can be left untreated. Severe cases of the condition, however, require surgical correction.
When it comes to problems associated with the defect, hypospadias can present with different issues depending on where the meatus (opening) is located. Some may find it hard to maintain cleanliness, whereas others may encounter problems in adulthood pertaining to reproduction.
What causes hypospadias?
Hypospadias is a congenital defect. The condition develops between the 9th and 12th weeks of gestation when the male reproductive organs begin to form in the embryo.
During this phase of development, the male hormones stimulate the formation of the urinary tract as well as the penile foreskin. Fluctuation in hormonal levels and actions is said to result in hypospadias.
Hypospadias requires no particular diagnostic test, as it is apparent at birth only. Not only is the meatus displaced, but the penile foreskin is also incompletely formed in most cases.
Although the exact cause of hypospadias is still unknown, experts suggest one of the following reasons may cause the defect:
- Genetics: Hypospadias is more likely to occur in boys with a family history of the condition.
- Fertility Treatment: Women who employ the use of hormone therapy or any other supplementary medication before or during pregnancy are more prone to giving birth to boys with hypospadias.
- Mother’s Age and Weight: Overweight women over the age of 35 are more prone to giving birth to boys with hypospadias.
- Environmental Factors: Exposure to environmental pollutants such as smoke, insecticides, and pesticides increases the risk of hypospadias development.
Mothers can minimize the risk of their child developing hypospadias by avoiding smoking or drinking during pregnancy, maintaining a healthy weight, and taking folic acid daily after consulting with the doctor.
What are the different types of hypospadias?
Three main variants of the condition have been devised based on the location of the urethral opening.
- Subcoronal: Meatus is located near the head of the penis
- Midshaft: Meatus is located near the penis shaft
- Penoscrotal: Meatus is located at the meeting point of the penis and the scrotum or on the scrotum.
Over 80% of the boys affected by the condition have distal hypospadias. 15% of the cases report a downward curvature of the penis. Curvature is observed in more than 50% of the cases in which the meatus is located more proximally.
How can you treat hypospadias?
If the location of the urethral opening is near the tip of the penis, surgical intervention is not necessary, and the child may not need treatment altogether.
However, most hypospadias cases require surgery to move the urethra, as well as its opening.
The surgery typically involves four steps:
- Straightening the penis shaft
- Creating the urinary tract
- Positioning the urethral opening at the head of the penis
- Reconstructing the penis foreskin
The purpose of hypospadias surgery is to create a normally functioning penis with a urethral opening situated as close to the penis’s ventral tip as possible. The surgery ensures the formation of a proper urinary stream as well as a straightened penis upon erection.
Hypospadias repair surgery is a routine procedure with a very high success rate. The surgery is performed when the child is between 3 to 18 months of age. The procedure is usually one to three hours long, and most children are allowed to go home on the same day.
Regular cases of hypospadias typically require a single surgery. Complex cases of the condition, however, may entail multiple procedures.
What are the possible complications of hypospadias?
Hypospadias, if left untreated, may result in a few complications including:
- Abnormal Urinary Stream: Untreated hypospadias results in spraying or an irregular urinary stream depending on the direction of the urethral opening.
- Curving Penis: Untreated hypospadias can cause the penis to curve over time as the child grows. This can result in sexual issues when the child reaches adulthood.
- Infertility: In cases where the meatus is located near the scrotum or perineum, the child may struggle with fertility problems in adulthood.
A common question that arises in this regard is: Does hypospadias affect puberty?
The answer to this question is no; it does not.
Hypospadias does not affect the natural growth progression of a boy into a man. The child ages as per usual and no specific issues arise in this regard. Untreated hypospadias, however, can become the source of impaired reproductive ability and sexual activity.
What should you expect after the surgery?
A small catheter is often placed in the penis after the surgery to avoid contact with the surgical site and to allow it to heal. After the surgery, antibiotics, and bladder antispasmodics are prescribed occasionally.
The most common complication associated with hypospadias repair surgery is the formation of a fistula (hole) between the urinary tract and the skin.
Scarring may occur in the channel or at the urethral opening, which may further interfere with urination. Scarring may additionally impair the wound from healing completely.
If you notice urinary leakage from another opening or a slow and unsteady urinary stream, consult the child’s doctor immediately.
Most complications associated with hypospadias repair surgery, however, can be easily rectified with the help of surgery.
Hypospadias is a common condition that, although concerning, is easily manageable. Cases of hypospadias vary in severity; therefore, we recommend seeking a professional’s opinion.
Consult a pediatric urologist to address any queries and find the best treatment approach for your child.