Hypospadias

What is Hypospadias?

Occurring in 1 in 300 males, hypospadias is an abnormality of the penis, with 3 basic features. Firstly, the urethra fails to reach the tip of the penis and opens somewhere on its undersurface. This can be anywhere from just below the tip, and as far as in front of the anus, in a very severe case. In addition, the foreskin is normally deficient on the undersurface of the penis, and the penis itself is curved in a downward direction. This latter curvature may either be due to the short skin on the undersurface, tethering the penis down, or to an inherent curvature of the penis itself, characteristic in more severe cases.

The majority of hypospadias is found towards the end of the penis, and can be corrected with a single stage procedure. More severe hypospadias and in particular, that where the hole is more highly located and there is an associated bend of the penis, (or chordee), require a 2 stage procedure. The first stage straightens the penis and a graft is placed on the undersurface, between the urethral opening and the penile tip. At the second stage, 6 months later, the graft is used to create the urethra, taking the orifice to the tip of the penis.

All hypospadias surgery will leave the penis with a circumcised appearance – i.e. the excess skin will be removed. Reconstruction of the foreskin to provide a functional (normal) foreskin is difficult, as there is a relative lack of excess skin; attempts can result in complication and ultimately additional surgery.

Hypospadias surgery is undertaken with a night in hospital. After the operation, it is usual to leave a catheter and special foam dressing around the penis. The timing of surgery is usually towards the end of the first year of life, for a single or first stage procedure. Patients stay in hospital overnight and keep the dressing and catheter in situ for 1 week, during which time, they take painkillers and antibiotics. The catheter and dressing prevent the child from having a bath, though the catheter drips continually into the nappy and it is usually very straightforward to manage.

After a week, for a single stage procedure, the dressing is removed by our nursing staff. If this is the first of 2 stages, the dressing is secured with sutures and requires removal under general anaesthetic, by the Surgeon.