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Hypospadias

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What is hypospadias and what causes it?

Hypospadias is a congenital (present at birth) problem affecting a boy’s penis. It is a combination of three separate problems: the hole through which urine passes (meatus) is not at the tip of the penis, the foreskin is gathered at the back of the penis with none at the front and the penis may be bent when stiff. The position of the meatus varies; in some boys, the hole is only a small distance away from the tip of the penis, whereas in others, it is at the base of the penis, in the scrotum or behind the scrotum.

How is hypospadias diagnosed?

Hypospadias is usually diagnosed by clinical evaluation . The appearance of the penis is not normal. The stream of urine is poor and coming from the underside of the penis and not from the tip of it.

On examination of penis, the undersurface of penis is not developed. The meatus is situated proximally and narrow. The muscle coverings and skin is deficient. The penile shaft is bent downwards, a condition called as Chordee.

Circumcision should be avoided in these children,as these local skin is mobilized to correct the defect during surgery.

How is hypospadias treated?

Effects of Hypospadias & Chordee: During childhood, urinary stream is poor and falls between the thighs, this affects the child psychologically as he feels low self esteem compared to peer group & school.

In adult life, it poses problem in intercourse during married life and may cause infertility as semen cannot be discharged from the tip of penis.

Treatment: Timely Surgical Correction under General Anesthesia, is the only treatment in hypospadias associated with chordee. It may be done in One or more stages

AIM of surgery; cosmetic and functional.

1). Cosmetic: A normal appearanceof penis with straight shaft, uniform thickness, an adequate conical glans, a good urethral diameter and meatus at the tip of glans penis is the aim.

2). Functional: Straight shaft on erection so that urine stream comes out from the tip just like normal infants. In adults, Straight penis of uniform thickness with meatus at tip so that semen discharge is from the tip of penis.

Timing of Surgery: 1 year to 3 years of age, before going to school. It depends on weight and nutritional status of child, anthropometry of penis and; associated anomalies like hypogonadism, undescended testis, DSD, etc.

Stages; One or Two stages usually, sometimes more stages depending on severity of condition and healing.

Complications: Infection, Bleeding, Fistula , stenosis, stricture, flap necrosis, diverticula formation. All can be corrected.

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What does the operation involve?

Are there any risks?

For about 2-3 in 10 boys, the original hole opens up again, so that your son passes urine through two holes. This can happen at any point after the operation, and will need to be fixed in an operation.

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What happens after the operation?

When you get home

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What happens next?

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