HYPOSPADIAS

It is an abnormality of penis and urethra (a tube connecting the bladder to the tip of the penis, for passage of urine) that is present at birth. Usually the opening of urethra is at the tip of penis, in hypospadias, this tube does not form properly and opening lies on the under surface of penis. It is a common condition with incidence of 1:300. It can range in severity. Abnormality is mild in 70% of cases(opening near the tip of penis), In 30% of cases, it can be serious(opening on the shaft or at the base of the penis). Unless it is very mild, hypospadias usually requires surgery.

It is recurrent hypospadias after multiple surgeries with significant penile deformity and unavailability of sufficient penile skin for subsequent repair. The reconstruction is difficult and challenging and always requires two stage procedure.

The exact cause is unknown. The penis develops early in gestation. External factors are not usually a contributing factor. The penile development need male sex hormones such as testosterone. The effects of testosterone on the growing penis may be blocked in some way. Although it is not a genetic condition, hypospadias can run in some families.

The more proximal the opening is the more severe the symptoms are;
 Mal positioned urethral opening, instead of being on the tip, at the underside of penis
 Double or sprayed urinary stream
 Hooding of foreskin at the top of penis with none being on the under surface
 Curved and bent penis(chordee; tightening of tissue on the under surface of penis, causing abnormal curvature downward, more prominent during erection)
 In adult difficulty in Sexual intercourse
 Psychological problems about being 'different' to normal are common

The diagnosis is usually made with history and physical examination. No other test are required in routine. In cases of other abnormal finding in perineal region or additional symptoms, workup to rule out syndromes is needed.

Treatment is surgical. Operation is usually done around one year of age but can performed earlier or later. The foreskin is utilized for correction of hypospadias, so circumcision is not advised before the corrective surgery
Surgery can be one stage or two stage depending upon the severity of disease.
The aim of the surgery is to re locate the urethral opening at the tip of penis for normal passage of urine in standing position and correction of penile curvature so as to make penis looks as normal as much possible. Surgeon rearranges the soft tissue by utilization of local flaps and skin grafts(usually from foreskin) to reconstruct the urethra and urinary meatus so that it can reach the tip of penis. A catheter(tube to drain urine) will be left for about one week after surgery to protect the repair. Initially penis looks appear swollen and bruised, but it settles down soon. Care should be done at home as per the doctor’s instruction to avoid complications.

 Is there any alternative to surgery? The most effective treatment is surgery, hypospadias can not be corrected without surgical
intervention.
 What are the complications of surgery?
Every procedure carries some risks, the complication includes bladder spasms (due to urine tube), infection, bleeding, wound breakdown resulting in fistula(hole in the urethra between where the urethral opening was and its new position), narrowing of opening (stricture) causing difficulty in passing urine and incomplete correction of problem
 What is the duration of procedure?
Operations usually last one-and-a-half to two hours and it is performed under general anesthesia.
 How long is the hospital stay?
It is done either as a day case or with a brief hospital stay.
 What is the long term outcome?
When properly and timely corrected, there are usually no long-term problems with passing urine or sexual function. A natural appearance is usually restored.
 What is the success of the procedure?
Surgical correction is usually very successful.