Treatment for Hypospadias
Cases of hypospadias in which the urethral opening is near the tip of the glans do not require treatment if the urine stream is straight and there is no chordee.
Moderate or severe hypospadias requires surgery to achieve the following:
- Allow the patient to urinate while standing
- Correct curvature of the penis (chordee)
- Present a cosmetically acceptable appearance
- Preserve fertility
Surgery is usually performed under general anesthesia when the child is between the ages of 6 and 18 months. Techniques vary considerably from case to case and may involve stages. Before surgery, testosterone injections or creams may be used to increase penis size and antibiotics are administered to lower the risk for infection. A catheter is inserted into the bladder to drain urine.
First, the anatomy is thoroughly assessed. The penile skin is retracted and any curvature is corrected by removing the hardened tissue or pinching (plicating) tissue to offset the curvature. Then, the urethra is extended using local tissue from the foreskin and the opening is repositioned at the tip of the glans. If an adequate amount of tissue is not available, tissue from inside the mouth may be used. Finally, the penile skin is replaced and sutured.
Hypospadias Surgical Complications
Local swelling and minor bleeding are common following surgery to repair hypospadias and usually are not severe. Antibiotics are continued after the procedure and infection is rare. Complications include adverse reactions to anesthesia and excessive bleeding that may require additional surgery.
Long-term complications that may require additional surgery include the following:
- Development of an abnormal opening from the urethra to the skin (fistula)
- Narrowing of the urethral opening (meatal stenosis) or the urethra (stricture)
- Formation of ballooning of the urethra (urethral diverticula)