Hypospadias
Hypospadias is a birth defect found in boys. The opening of the penis through which urine exits the bladder (penile meatus) is not at the tip of the penis. This occurs in 1 out of 300 live male births. There is some risk of this running in families. Up to 14% of male siblings are also affected.
With this, the further back on the penis the opening is, the more severe it is. The most severe types can have the opening at the region of the scrotum. Some may even have it in the region between the anus and scrotum.
Hypospadias can occur with a defect called chordee. Chordee is a downward curve of the penis. Both of these must be repaired so that a child can pass urine normally. Repair is also needed in order to have normal reproductive health.
Development
As a male fetus develops, the penis begins to form in the sixth week of fetal life. Two folds of tissue join each other in the middle. A hollow tube is formed in the middle of the future penis. This tube is the urethra. As the skin folds grow to form the penis, any pause in this process leads to the meatus being found in a place further from the end of the penis. The exact cause for this is not fully known.
Reasons to Treat
When the repair is done, the urethra is brought to the tip of the penis where it is supposed to be. Also, any bend is straightened. This is needed for many reasons. When the opening is too far under the penis, a male is not able to stand and pass urine like other boys. It is harmful to a boy’s normal social growth to have to sit while he passes urine. A straight penis is needed for normal reproductive health and sexual function.
Treatment
At first, when the child is born and the defect is found, any thoughts of circumcision should be delayed until the baby is seen by an urologist. This is because the foreskin can provide needed skin to rebuild the urethra. The exact type of operation done varies based on how severe the defect is. For the defects that are closer to the normal spot at the end of the penis, a new tube can be created from the skin on the penis.
We often schedule repair about the time a child is one year of age. This way, the boy is in diapers and the care of dressings is easier. But, the exact age of repair can vary based on the size of the penis and how severe the defect is. We have been able to repair most of the children with a single operation. Sometimes a second repair may be needed. This is performed under general anesthesia with the child fully asleep. Most of the boys will have a small tube coming out of the tip of their opening. This “stent” will protect the new urethra and allow for proper healing. Most patients will go home the same day or the next day. More complex repairs may have a longer stay due to the need for bed rest.
If you have any questions, please contact the Pediatric Urology Clinic at (608) 263-4757.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 05/06/2010
Copyright © 05/06/2010 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#6319
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