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The mal development of the urethra leads to defective urination and the inability of insemination; i.e. inability to ejaculate inside the vagina which may lead to infertility.
Another important disadvantage is the deterioration of the psychological development of the child starting at school age. That is why there is a lot of attention paid to the condition and its operative correction in particular before school age.
This disease is described as the failure of development of a part of or all of the urethra during the development of the baby inside the uterus. The failure may be in part confined to the end of the penis „distal hypospadius, to the middle of the shaft „peno scrotal“ or the base of the penis „scrotal or proximal hypospadius“.
The urethra develops from a special plate on the lower aspect of the penis. This is called the urethral plate. Failure in the development and tubularization of this plate results in hypospadius.
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Normal penis
Note that the external opening of the urin (external meatus)
is at the tip of the penis
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Simple hypospadius
Note that the external orifice of
urine is situated behind the
glans penis |
Sever hypospadius
Note that the external orifice of
the urine is situated far behind
the glans penis on the lower
aspect of the penis |
Who qualifies for the operation?
Children starting from 6 months up to pre-school age. Every patient who suffers with the problem even if discovered later in life is considered to be a candidate for the operation. The correction of the disease helps the psychological development and the attitude towards the opposite sex.
How does the operation work?
Hypospadius is a big challenge for the surgeon. It means examining the patient and planning which operations technique should be done under strict sterilization in a suitable time to keep the time of anesthesia to a minimum. The challenge is to find a hairless part of skin with a suitable blood supply to cover the defect preserving the cosmetic appearance of the penis. The penis should be straight, functional and cosmetically good. The site of skin chosen for the coverage of the defect may be the foreskin, the side of the penis, the inside of the upper arm, the mucus membrane of the mouth or recently AlloDerm with patients own cells (still experimental).
The child lies on his back. The penis is sterilized. The area is studied again in order to plan for the harvesting of the skin, which may be a free part of skin or a part attached to its blood supply rotated to the area to be restored. The penis is artificially erected to discover any curvatures that should be corrected in straightening it.
The skin is laid on the defected area as a sheet which should be wide enough to permit a catheter of 10 Ch. diameter and to avoid any narrowing of the future urethra or meatus (outer opening of the urethra).
The covering skin is then sutured to the remaining plate of the urethra in a water tight double layer using fine sutures and microsurgical magnification. The new urethra is then covered with the mobilized skin of the penis. The penis is wrapped in compression bandages.
Healing:
The catheter will remain inside the bladder as a draining tube and a supporting catheter for the urethra for three days. The wound is inspected daily. The child is dismissed after the three days. I inspect the wound every two days until it is completely healed. Follow up is done after 3 and 6 months to discover the development of holes (fistula) inside the urethra which should be repaired accordingly.
How to prepare for the operation?
Please see the chapter on preparation of the patient
Frequently asked questions (FAQ):
- What is hypospadius?
It is a developmental defect of the urethra.
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- Does it interfere with erection?
Hypospadius is sometimes accompanied with penile curvatures which renders a straight erection suitable for penetration difficult.
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- Does hypospadius affect the psyche of the child?
Yes, it leads to a deformed penis which sometimes looks ugly and which is criticized by his school mates.
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- Is there an ideal age for the correction of hypospadius?
Yes, the best time to correct hypospadius surgically is as early as possible and before school age to avoid the child becomes aware of the problem and to protect him from the criticism by his school mates.
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- Can one treat hypospadius with medications?
No this is only possible through an operation.
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- How does hypospadius affect fertility?
The presence of the opening of the penis (meatus) not exactly at the tip of the penis in cases of proximal hypospadius renders the intrauterine insemination difficult resulting in infertility.
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- Does hypospadius have any effect on the bladder or kidney?
Yes, the meatus of the urethra is narrow in some cases of hypospadius which may lead to back pressure which is reflected in the bladder and in advanced cases to the upper urinary tract (the kidneys).
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- What is a fistula?
A fistula is a button like defect which may appear after the surgery of hypospadius due to shortage of the blood supply of any part of the suture line or due to infection in the area operated upon.
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- Can the surgeon correct fistulas?
Yes, this is done at least 6 months after the first operation.
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- Is it possible that hypospadius recur?
Yes, if there is a shortage of blood supply, scaring or infection.
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- Is it possible to re-operate a recurrent hypospadius?
Yes, but it is more difficult to repair because the skin for recovering the defect is very limited. One should wait at least 6 months before the operation can be repeated.
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- Why do you use the mucous membrane of the mouth in some cases of repair of hypospadius?
This is because the mucous membrane of the mouth is very similar to that of the urethra and it is very elastic and heals well.
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- What are the complications of the taking the mucous membrane of the mouth?
The most important possible complications are infection or injury to the salivary duct.. Shrinking of the graft is aslo possible if its size is not well planed.
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