Hypospadias is a congenital abnormality that affects some male children, with an estimated incidence of around 1% of male births worldwide. It involves a displacement of the opening of the urethra from its natural position at the tip of the penis to a location below the normal area, to varying degrees.

 

The causes of hypospadias in most children are unknown. In most cases, it is believed to be the result of a combination of genes and other factors, such as environmental influences that the mother encounters, what she eats or drinks, or certain medications she takes during pregnancy.

• Age and weight: Women who are 35 years of age or older and are obese are at the highest risk of having a child with hypospadias.

• Fertility treatments: Women who use assisted reproductive techniques are at a higher risk of having a child with hypospadias.

• Certain hormones: Women who take specific hormones before or during pregnancy are more susceptible to having a child with hypospadias.

Many parents wonder if surgery is necessary for different forms of hypospadias. It is difficult to predict the problems a child will face later in life. However, there are several reasons to recommend correction regardless of the severity of the condition, as boys with hypospadias may have other associated issues, including:

• Chordee: This congenital deformity is often associated with hypospadias and involves the bending or curvature of the penis. Up to 15 out of every 100 boys with hypospadias will have a downward curvature of the penis. In severe cases, this curvature can interfere with achieving effective erections in adulthood.

• Urinary problems: These deformities affect the urinary stream, and children with hypospadias may experience abnormal urine spraying, either to the sides or downwards, and may need to sit to urinate. Urination can also cause discomfort and irritation to adjacent tissues.

• Undescended testicle: About 8 out of every 100 boys with hypospadias also have a testicle that has not fully descended into the scrotum.

• If hypospadias is left untreated, it can lead to later-life problems, such as difficulty with sexual intercourse or difficulty urinating while standing.

Studies conducted on boys with hypospadias indicate a lack of self-confidence. Therefore, doctors prefer to correct all forms of hypospadias, as the benefits far outweigh the risks of surgery.

 

1. Mild cases: The urethral opening is located slightly below its natural position, still present alongside the head of the penis.

2. Moderate cases: The opening is located further along the shaft of the penis than in the previous category.

3. Severe cases: The opening is completely displaced from its natural position and may deviate towards an area close to the scrotum.

In all these cases, attention should be given to the presence of penile curvature, as mentioned earlier.

 

Hypospadias is often noticed at birth, and the diagnosis is made during a physical examination after the baby is born.

 

• The treatment of hypospadias depends on the type of defect the boy has. Most cases of hypospadias will require surgery to correct the abnormality.

• If surgery is needed, it is usually performed when the boy is between 3-18 months old.

• The surgical goal is to create a straight, natural-looking penis with a urethral channel that terminates at or near the tip.

• The surgery involves two aspects of treatment: first, correcting any curvature or bending of the penis, and second, adjusting the location of the urinary opening by placing the urethral meatus in the correct position.

• Infant circumcision should not be performed on a child with hypospadias because the doctor may need to repair the skin around the urethral opening.

• After the surgery, Dr. Wael Ghanem, a plastic surgery consultant and congenital defects repair specialist, temporarily places a catheter, a small tube, to ensure the protection of the new opening.

• Most children are discharged from the hospital one day after the surgery or on the same day, as advised by the doctor.

• Hypospadias repair is often done within 90 minutes to 3 hours. In some cases, the repair takes place in stages. The doctor often wants to straighten the penis before creating the urinary channel.

• Some pain may result from the surgery, but it is relieved by taking the recommended pain medication by Dr. Wael Ghanem.

 

It seems that younger boys feel less discomfort after the repair surgery. When the surgery is done between 6 and 12 months of age, the child does not remember it. Older boys cope well with this surgery, especially with the required medication during that stage. Some cases require medication for bladder spasms.

 

The wounds from the hypospadias repair surgery do not require special care for healing. Professor Dr. Wael Ghanem, consultant plastic surgeon and reconstructive surgeon for congenital defects, will guide you on how to care for the wound and bathing conditions.

The doctor may leave a small tube called a catheter in the penis for a few days after the surgery to prevent urine from touching the repaired area. The catheter drains into the diaper, which can be changed as usual. In older children, the catheter may be connected to a bag. The medical team of Professor Dr. Wael Ghanem will teach you how to empty the bag. The catheter is often left in place for 5 days to 2 weeks, and antibiotics are given while the catheter is in place.

 

Wound healing from hypospadias repair begins immediately, but it may take several months until full recovery. There may be swelling and bruising in the early stages, which improve over a few weeks. Another surgery will not be performed for at least 6 months to allow the tissues to heal. Many minor defects will also resolve during this time.

 

• Hypospadias is not always a hereditary deformity, although it may be observed in some cases where family members have experienced the same problem. It is a possibility that does not exceed a 20% chance.

• Among the significant outcomes of hypospadias treatment are the preservation of sexual function and future fertility for the child, as well as the prevention of urinary tract infections resulting from improper urination.

• The child is advised to consume plenty of fluids after the surgery.

• The child will have follow-up appointments with Professor Dr. Wael Ghanem, a plastic surgery consultant and repairing congenital defects, after the surgery, as advised by the doctor.

• Successful repair results are lifelong, along with adaptation to penile growth during puberty.

 

Prof. Dr. Wael Ghanem, consultant in plastic surgery and congenital defect repair, encourages early intervention to treat hypospadias, regardless of its severity or complexity, because the procedure is simple and very safe, ensuring the restoration of the shape and function of the child’s organ.