Hypospadias Hypospadias is a Genital Defect of the penis. In Hypospadias, the opening of the urethra is on the under surface (under side) of the penis instead of being on the tip. In Epispadias, the urethral opening is on the upper side of the penis. The urethra is a tube that carries the urine and semen and opens on the tip of the penis. What are the types of Hypospadias? 1) Glanular Hypospadias – The urethral opening develops just below the end of the penis. 2) Coronal Hypospadias – The urethral opening develops in the groove where the head of the penis (glans) meets the shaft. 3) Penile Shaft Hypospadias – The urethral opening develops anywhere along the underside of the shaft of the penis. 4) Perineal Hypospadias – The urethra opens in the scrotum. What are the long term implications of Hypospadias or Epispadias for my child? Boys with Hypospadias are more likely to have Undescended Testes. The most common implications of Hypospadias are difficulty urinating. It is difficult for the child to urinate standing as the stream of urine splatters all over the place. The cosmetic appearance of penis in Hypospadias is different from other boys which can be a cause of anxiety. The penis in Hypospadias may be curved which might make it difficult to have sexual intercourse and / or cause painful erections (Priapism). Boys who have Hypospadias are also more prone to urinary tract infections due to a short urethra. Hypospadias may be associated with infertility to some extent as the urethral opening might be too far off on the shaft of the penis and may make it difficult for the semen to be ejaculated in to the vagina. Why is surgical correction of Hypospadias important? It is important to have the corrective surgery for Hypospadias for your child to enable him (as he grows older) to have a normal sexual relationship and be able to urinate standing up. What does the surgical correction of Hypospadias involve? Surgical correction of Hypospadias is performed in the first year of life as healing is faster and formation of scar tissue is much diminished. Do not circumcise your child before the corrective surgery for Hypospadias has been performed as the foreskin on the penis will be utilized for surgical re-construction of Hypospadias. The procedure for surgical repair of Hypospadias is performed under general anesthesia in a hospital setting. Several different techniques are used for the surgical correction of Hypospadias and Epispadias. The basic goals of all of these techniques is to 1) straighten the penis, 2) extend the urethra so that it opens on the tip of the penis, 3) and reconstruct the skin around the urethral opening. A simple operation or multiple surgeries may be required to repair Hypospadias. Your child will stay in the hospital for 2 days after the Hypospadias surgery. How to prepare your child for Hypospadias repair? Your child will be hospitalized the night before Hypospadias repair, you will be instructed not to feed your child any food or drinks for at least 10 hours before the operation. Inform your surgeon and anesthetist if your child has any medical conditions or allergies to any medications. What to expect during the recovery period of Hypospadias repair? After spending a couple of hours in the recovery room, your child will be brought back to room and he can be fed now. There will be a large dressing on the penis and a catheter will be inserted for the urine to drain from the urethra following Hypospadias repair. There will be pain and soreness after the surgery, your surgeon will prescribe medication for pain relief. Keep the dressing dry and clean to avoid infection at the incision site. Do not give your child a bath after the Hypospadias repair until the dressing comes off. You will be instructed to come back to the hospital after a week to get your child’s dressing and catheter removed. Your child’s penis may look red and swollen which will settle down within the next few weeks. What will happen if my child has surgical correction of Hypospadias as an adult? The chances of postoperative complications will most likely increase if Hypospadias repair is performed on an adult. Amongst other problems, the most outstanding one is decreased sex drive and sexual activity which can be considered to be the most serious one. What is the outcome of Hypospadias repair? The goal of the Hypospadias surgery is to permit urination standing up and to have satisfactory sexual relationships. Surgeons specializing in uro-genital surgery use best of techniques to give the penis an appearance which comes as close as possible to the normal looking one. In these techniques, a urethral meatus is created on the tip and the penis has a circumcised appearance. Benefits of surgical correction of Hypospadias Hypospadias repair can improve the appearance as well as the functional problems of your child like urination, sexuality and reproduction. Hypospadias repair surgery straightens the penis especially during erection, re-positions the opening of urethra, urination is possible in a straight stream and of course your child’s penis is normal in appearance. Risks of surgical correction of Hypospadias Urethral meatus too small – This is not too common however, if it occurs then a revision surgery is needed. Bleeding during operation Original hole opens up again – In this case your child urinates from two openings. This problem requires a revision Hypospadias repair. Urethral stricture – Narrowing of urethra is a very common problem following Hypospadias repair. This may happen due to formation of excessive scar tissue inside the urethra. Fistula formation – Leakage of urine through holes along the suture line Hair growth and formation of scar tissue – This can reduce sensitivity of the penis during sexual activity. Alternatives to surgical correction of Hypospadias There is nothing else that you can do for your child to correct this Genital Defect other than to have the Hypospadias repaired surgically.