Hypospadias Repair Surgery : Preparation, Techniques, Procedure & Recovery

Overview

Hypospadias is a condition where the external opening of the urethra (a thin tube-like structure that carries urine from the bladder) is at an abnormal place. Usually, the urethra opens at the tip of the penis (male reproductive organ). In hypospadias, the opening is seen on the underside of the shaft of the penis or at the back near the scrotum (a sac-like structure located under the penis that contains the testicles). The condition is diagnosed at the time of birth.
Surgery is the only treatment for this condition. It is usually done when the baby is 3 to 18 months old. Surgery usually restores the shape of the penis and the natural placement of the urethral opening. Successful treatment allows most men to pass urine and perform sexual activities normally.

What Is Hypospadias Repair Surgery?

Hypospadias is a common condition seen in 1 out of every 200 male babies. In this condition, the urethral opening is not at its usual place (the tip of the penis). This causes difficulty urinating. The penis is curved downward (a condition known as Chordee). Also, the foreskin is underdeveloped and bundled at the tip, giving the penis a hooded appearance. 
Hypospadias repair surgery is the surgical technique to restore the shape of the penis and the natural placement of the urethral opening. It also aims to correct the bend in the shaft of the penis. The technique involves using the foreskin to extend the length of the urethra. It is done between 3 and 18 months of age.

This surgery is done under general anesthesia. It is an outpatient procedure, meaning you can take your baby home once the effects of the anesthesia have worn off.
Your baby will have a urinary catheter in place after the surgery, which is removed after 10 to 14 days. A complete recovery takes about six weeks. 

When Is A Hypospadias Repair Surgery Recommended?

Hypospadias is usually diagnosed at birth. A clinical examination is the only diagnostic tool required in this case. The surgery is usually done when the child is between 3 and 18 months of age. 
Surgery is indicated when the surgeon notices the following:

• The urethral opening is not at its usual place. It may be located on the underside of the shaft or near the scrotum
• The foreskin is underdeveloped. It looks gathered at the top of the head of the penis and does not extend to the underside. This makes the penis look hooded.
• The foreskin appears to be hiding the abnormal opening of the urethra.
• There appears to be an opening at the normal place in the penis, but the urine comes from elsewhere.
• The testicles (2 egg-shaped glands present inside the scrotum) have not descended into the scrotum.

Sometimes, the urethral opening is only slightly displaced and may go unnoticed at birth. In such cases, the child may have the following symptoms as he grows up:

• Inability to pass urine in a straight line, the urine gets sprayed in all directions
• Inability to pass urine in a standing position
• Embarrassment due to the bent appearance of the penis

How To Prepare For A Hypospadias Repair Surgery?

Surgery to correct hypospadias will be suggested when the child is around 3 months of age. It is the parent's decision when to get it done. Ideally, it is best to get it done before the child turns 2.
Some days before the surgery:

• The surgeon will conduct a thorough physical examination to locate the opening of the urethra.
• Testosterone injections will be started for your baby. These injections help to widen the shaft of the penis. A wider shaft increases the chances of surgery succeeding.
• A few tests will be suggested:
  • Complete blood count- To check the overall health of your baby.
  • Urine analysis- To rule out any infections.
  • Cystogram and Urethrogaram- These are x-ray examinations of the bladder done to look for the blockages in the urethra.
• You will be asked for details about your baby’s general health condition. Any medical conditions he may have and medications currently being taken will be discussed. Allergies towards any particular medicine need to be mentioned specifically.
• You will be given instructions on when to stop feeding your baby before surgery.

How Is Hypospadias Repair Surgery Performed?

Hypospadias repair surgery is an outpatient procedure that takes 1 to 2 hours. Severe hypospadias may take more than 3 hours. You can take your baby home on the same day. 

Here is what happens during the procedure:

• The procedure is done under general anesthesia, which means the baby will be asleep and not have any pain.
• There are different methods to perform a hypospadias repair:
  • Urethroplasty- Once the anesthesia has taken effect, the surgeon will cut your baby’s foreskin. This foreskin is then made into a tube to lengthen the urethra as much as possible. A longer urethra helps the surgeon to move its opening to the tip of the penis.
  • Meatoplasty- In this procedure, the surgeon creates a new opening in the urethra and reconstructs the head of the penis (glans) to accommodate the new opening. Once the urethra is reconstructed and the opening has been fixed to the tip, the surgeon will insert a catheter into the urethra. This helps to hold the urethra in place. It is removed 2 weeks after the surgery.
  • Scrotoplasty- This is usually performed in cases of penoscrotal hypospadias. Once the opening of the urethra has been shifted to the tip of the penis, the scrotum is repaired and reconstructed. This surgery is usually performed in 2 parts, spaced 6 months apart.
• Once the urethral opening has been restored, a catheter will be inserted to hold the urethra in place. This catheter is left as it is and will be removed after 2 weeks.
• Once the surgery is completed, the surgeon will close the incisions with sutures. These sutures self-dissolve within two weeks.

What to Expect After a Hypospadias Repair Surgery?

Hypospadias is a daycare procedure. Once the symptoms of anesthesia wear off, you can take your baby home. There will be pain and discomfort for a week after surgery. You will be prescribed pain medications for the same. Your baby will need a urinary catheter 5 to 14 days after the surgery. This catheter is held in place with stitches. These stitches fall off after two weeks. An appointment will be made with the surgeon two weeks after the surgery to get the catheter removed. 

Here is how you can care for your baby at home after the surgery:

•  Follow all the instructions regarding postoperative care given to you while being discharged.
• Ensure that all the medications prescribed are taken on time.
• Change the dressing after 2 days. There may be some oozing and spotting on the dressing; this is normal and will decrease in a day. Once the dressing is removed after 2 to 3 days, the wound is left open to heal.
• Do not apply ointments or powder on the genitals. Keep the area clean and dry.
• Do not rub harshly on the genitals while bathing. The area needs to be completely dry after a wash. Any moisture left behind will cause infections.
• Keep the diapers loosely fastened. Change the diapers frequently (every 2 to 3 hours) so the baby does not have to stay wet for long. For older boys, loose-fitting underwear is recommended
• Feed your baby well. This ensures the urine is clear and clean.
• You may take your baby for a walk in the stroller but do not allow him to play in the sand or water. If your child is a little older, he should avoid activities like cycling and running.
• You need to be extra cautious until the catheter is in place. Once it is removed after 2 weeks, your child may begin being active. Complete recovery from the surgery will take 6 weeks. 

What Are The Benefits And Risks Of A Hypospadias Repair?

A hypospadias surgery restores the normal placement of the urethral opening. It also helps to decrease the bend in the shaft of the penis. As this procedure is done under general anesthesia, it carries some risks.

Benefits of hypospadias repair surgery

• Reconstruction of the urethra helps in normal urination
• Urine is passed in a straight line, with no spraying. 
• Urine is passed well in the standing position
• Correction in the shaft's bend boosts confidence and relieves social anxiety
• In later life, ejaculation during sex is normal.

Risks of hypospadias repair surgery

• General reactions to anesthesia like nausea, vomiting, and dizziness
• Swelling and bruising of the penis
• Infections on the wound
• Hematoma formation (collection of blood under the skin)
• Scarring of the tissue can lead to an altered sensation in the penis
• Development of an urethrocutaneous fistula. This is an opening on the skin of the penis that goes down and opens inside into the urethra.
• Formation of urethral strictures. Scarring can cause the urethra to narrow. This leads to slow urination and can build pressure in the kidneys and bladder.
• Shorter penis- This may happen if the surgery is done during or after puberty.
• Recurrence of the bend in the shaft of the penis may happen in rare cases.

Why Choose Medfin?

Surgery can be a daunting aspect, and feeling anxious is absolutely normal. The massive amount of information you can get from the internet may confuse you even more. This is where Medfin can help. Leave us the hefty task of finding the best hospital, the finest doctor, and the latest procedure at the lowest cost. Let us take charge while you sit back and focus on your health and recovery. Think surgery! Think Medfin!