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Little
baby boys pass urine like a fountain. Small lads can
stand and pass urine straight with an ability to point
the stream where they want, like a fire-man’s hose.
This is possible because the urine comes out of the
opening at the tip of the penis.
In boys with hypospadias, the opening is located on the
under surface of penis. Because of this the urine is
deviated downwards towards their feet. The picture shows
normal arrangement and hypospadias
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Hypospadias
occurs in one in 300 male newborns. When the
paediatrician checks out the baby, or when the parents
bath the baby, the following features can make one
suspect hypospadias
Urine opening on the under surface of the penis
Penis being slightly bent downwards
Excess foreskin on the top of the penis
What are the consequences of Hypospadias?
When hypospadias is left uncorrected, the following
consequences can develop
Unlike the normal lads who can stand and pass urine,
hypospadiac lads have to sit; if they stand and pass
urine, it goes down the leg.
When they get older, because of the bent in penis,
sexual activities become difficult. Also they have much
lower chance to have children, as they can’t deposit
the sperm normally. The sperm leaks out through the
opening located underneath.
Sometimes the urinary opening is also small, leading to
blockage in urine stream. This leaves them at a risk of
urinary infection.
Do they have other birth defects? Can the same problem
recur in future children?
In general, hypospadiac children do not have other
kidney abnormalities. However in 10% of these kids, the
testis may not be descended normally. When both testes
have not come down normally, they can have associated
hormone defects. When the first child or the father has
hypospadias, there is a slightly higher chance (7-10%)
for the future boys in the family to have the same birth
defect.
What is the right time to correct hypospadias?
From 6 months onwards, hypospadias can be corrected by
an operation. By completing the operation before 2-3
years of age, these children can be toilet trained
normally like any other child. Not having an appearance
like other boys at school, can lead to emotional
problems in these children.
What does the operation involve? What are the
complications?
Most of the hypospadias belong to the mild variety and
can be operated by a single stage operation. When the
opening is too far down from the tip, they might require
two-stage operation. The operation is usually done under
general anesthesia and a catheter/ dressing is left for
5-7 days. Three things are corrected during the
operation.
The opening is brought to the tip
The penis is straightened
Excess foreskin is removed (circumcision.
Optical magnification (microscope) and fine suture
materials are essential for a successful result. When
extra care is taken there is a very good (95%) success
rate. In 5% the following complications can occur.
The new opening gets small gradually (meatal stenosis)
Urine leaks at the original site (Fistula)
Both these can be corrected by another minor operation;
so the parents need not have undue concern about this.
What are the chances of fertility after operation?
Straight penis and an opening at the tip are essential
for a successful married life and fertility. When the
problem is corrected by 1-3 years of age with a good
outcome, there should be no problem in future for
fertility.
Key Points:
In children with hypospadias, the opening is on the
under surface of penis.
Because of this, these lads can’t stand and pass urine
like normal children.
They can have infertility in later life, if left
uncorrected.
By performing a corrective surgery at the right age,
these can be avoided.
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