Hypospadias Diagnosis & Treatment

Hypospadias is a birth defect in which the opening of the tube that carries urine is not properly placed at the end of the penis. Most cases of hypospadias are very mild and can easily be repaired with an outpatient surgery.

Diagnosis

Hypospadias is usually diagnosed in males at birth. Upon examination, the foreskin is usually incomplete and the urethral opening is misplaced. Mild hypospadias may not be diagnosed unless removal of the foreskin (circumcision) is performed.

Some pediatricians perform ‘partial circumcisions’. In this situation the pediatrician begins the circumcision procedure, and, after exposure of the glans, identifies a hypospadias.

Due to swelling after the procedure, the consequences of a partial circumcision may look bothersome at first, but after several days or weeks the inflammation reduces and the penis appears much better over time.

The reason a pediatrician aborts a circumcision is because the extra foreskin can sometimes be useful for the surgical repair. After hypospadias surgery the boy will often look circumcised.

Treatment

Cases of hypospadias in which the urethral opening is near the tip of the glans may not require treatment if the urine stream is straight. Moderate or severe hypospadias requires surgery. The intended result of surgery is to allow the boy to urinate standing up at the toilet.

Additional reasons for surgery include to improve cosmetic appearance, correct any curvature, and to help with future fertility by proper forward ejaculation.

Surgery is usually performed under general anesthesia when the child is between the ages of 12 and 18 months. A catheter is sometimes inserted into the bladder to drain urine. This may be left for several days after the procedure to help with proper healing.

At the time of surgery the anatomy is thoroughly assessed. The penile skin is retracted and any curvature is corrected. Then, the urethra is extended using local tissue and the opening is repositioned at the tip of the glans.

Finally, the penile skin is replaced and sutured. A dressing is placed at the end of the procedure. This will usually fall off in the first several days (or hours), but should be removed on post-operative day three.

Surgical Complications

It is very common for bruising and swelling of the penis to last several weeks. The penis can swell significantly and often turn purple. In addition, some areas of dead skin tissue can have the appearance of a scab. Mild bleeding can occur from the incision as well, although this usually stops after three days.

Prognosis

The prognosis for hypospadias depends on the severity of the condition. Most patients with distal hypospadias have an excellent prognosis and cosmetic result after surgery.