A guide for parents of children with hypospadias
What is hypospadias?
In boys, the name of the abnormality in which the external urinary hole, which should be at the tip of the genitals, opens somewhere on the underside of their penis, is hypospadias in the medical language. People with hypospadias use the terms "prophet circumcised" or "half circumcision". It is a very common congenital anomaly. It occurs in one in three hundred live male births. Children of fathers with hypospadias have a higher risk of developing it. Such children are born as if they were half circumcised. When looked carefully, it is noticed that they urinate towards their legs and under their penises. Even if there is a hole-like appearance at the far end, this is blind, and urine does not come from here. There is no foreskin on the underside of the penis. The one on the lower face is the external urethra, which should normally be at the very tip. Sometimes this hole is much narrower than it should be. Then these children will pee as fine as top thread, and it will take a long time for their pee to run out. As the urethra moves away from the tip of the penis, the severity of the disorder increases, while the probability of its occurrence decreases. The most common form is the type close to the tip of the penis (glandular), and the least common type is the perineal type.
In such children, the first thing that attracts attention of their families is the curve of the penis towards their testicles. In most patients with hypospadias, there is a band extending between the existing urinary hole called "chordee" and the tip of the penis. This band causes the penis to bend forward during the erection of the penis. This formation is removed during surgery.
All patients should also be systematically investigated for other organ anomalies that may be present. Undescended testis, kidney anomalies, hernias and other congenital anomalies can be found with hypospadias.
How is it noticed?
Careful parents or pediatricians suspect that the foreskin is half-formed. Sometimes it is noticed that the urine does not gush from the tip. Although this hole is mostly on the underside of the penis and close to the tip, in some patients, it may even be behind the penis, between the testicles or in front of the anus. The farther the faulty hole is from the head of the penis, the more severe the abnormality. Some parents notice the curvature first. Rarely, in some cases of hypospadias, the foreskin development is complete, and if care is not taken, hypospadias in these children may be overlooked.
What are the causes?
The disease occurs during the development of the baby in the uterus. It occurs as a result of the inability of the tissues that will form the part of the urinary tract located on the penis to be folded to form a tube. Hormonal causes, lack of response of the baby's tissue to the hormone and environmental factors are responsible for this developmental anomaly.
Can these children have children in the future?
They can happen if the wrong treatments are not applied. During erection, curvature of the penis may occur. Untreated men with hypospadias may find it difficult to have children in the normal way because of the problems they may experience in transferring their sperm to their partners. In particular, the complete correction of the curvature is very important both in terms of having a child and not having a problem in sexual intercourse. In our time, these patients can be fully healed by using modern surgical principles and choosing appropriate methods. Mental problems that affect their whole life may also occur in children who are treated late and who do not fully recover despite being operated many times because competent hands did not intervene. In severe hypospadias cases, further tests are recommended in hypospadias cases where testicles cannot be found on examination.
What are the treatment requirements?
In severe hypospadias cases, hypospadias repair is essential to ensure standing urination, sexual contact, and insemination.
What is the ideal treatment age?
The penis is expected to reach a sufficient size for the surgery. This period is determined by the surgeon. However, it is recommended that the surgeon be experienced in this regard, because correcting faulty operations is much more difficult than the first operation. The ideal age for surgery is between 6 months and 1.5 years. At this age, both surgery and post-operative care are much easier than adults. In addition, patients who have undergone surgery and recovered at this age do not remember that they have experienced such an event in the future. This is also an important advantage. In children who have missed these ages, surgery should be performed as soon as possible without waiting any longer. There is no upper age limit. First, it is recommended that children with hypospadias not be circumcised. The foreskin will form the backup skin source to be used during the surgery to create a new urinary canal or to close the front of the penis. It is generally preferred that the surgery be performed before the child starts school. Many techniques are available for surgery and will depend on the preference of the surgeon.
What are the goals of hypospadias surgery?
The main goals in surgical treatment are: A straight penis with a completely corrected curvature that may prevent sexual contact, being able to urinate by squirting from the very tip of the penis, obtaining the appearance of a circumcised child, and treatment at a young age without realizing that such an abnormality exists.
How is the surgery done?
There are many repair techniques described for the treatment of hypospadias. Depending on the severity of the disease, it may be necessary to perform a single or several-session surgery. Hypospadias surgery is an extremely sensitive and delicate procedure. It should be done by pediatric urology specialists who are specialized in this work, using magnifying glasses and special threads. During the operation, after the curvature is corrected, the urethra is extended to the tip of the urethra, mostly by using the foreskin. Thus, the child becomes circumcised . The duration of the operation varies depending on the mild, moderate and severe hypospadias disease, whether the case is operated for the first time or repeatedly, and the type of technique used. On average, it can take 1-1.5 hours.
What are the features of the postoperative period?
Some of the patients are sent home on the day of surgery, and some are sent home 1-2 days later. After the operation, there is a special dressing around the penis. A plastic tube inserted into the newly formed urethra and coming out of the tip of the penis serves to drain urine. After more severe hypospadias surgeries, a second tube that enters the bladder directly from the lower abdomen and is also used to drain urine can be placed. These are necessary for the safety of the newly created urinary tract and are removed 7 - 14 days after the operation. After the surgery, some swelling and edema may occur on the glans. During this period, it is important that the tubes are not blocked, and attention is paid to the patient's oral intake of plenty of fluids. After the surgery, antibiotics, painkillers and drugs to prevent bladder cramps are used. After the catheter is taken, the drugs are stopped, and bathing is allowed. During and after this period, dangerous sports and movements are avoided for about 1 month. However, daily movements are not restricted. All the fine sutures on the penis are self-melting and do not need to be removed. In the first periods, there may be forked urination. It gets better day by day. Sometimes it may be necessary to enlarge the newly made hole at certain intervals. For second surgeries, which are rarely necessary, at least 6 months must pass. The easiest patient group to care for after hypospadias operations is diaper babies. This age group is the most comfortable post-surgery.
What are the complications of the surgery?
Complications after hypospadias repair; bleeding, wound infection, collection of blood between the tissues, fistula between the newly formed urinary tract and the skin, urinary hole stenosis, ballooning in the urinary tract, complete opening of the newly constructed urinary tract and necrosis on the penile skin. Fistulas are the most common complication. A fistula is a hole that occurs at any point of the urinary tube in the surgical area. During urination, urine comes out from both the tip of the penis and the fistula. In this case, a re-operation will be required to close the fistula at a suitable time, for example, after 6 months. This period is necessary for the softening of the tissues in the surgical area.
Children who have successfully undergone hypospadias surgery return to normal completely. They are no different from normal men in terms of urination and future sexual functions.