Hypospadias at a Glance
The congenital defect called hypospadias is usually noticeable the moment your son is born. In a normal penis, the opening of the urethra (the tube which carries both urine and sperm out of the body) is located at the end of the penile shaft. In an infant born with hypospadias, the opening of the urethra is located either underneath the head of the penis and even as far back as the area between the penis shaft and the scrotum (severe). There are cases when the opening of the urethra is located at the perineum. This common birth defect affects one out of every 250-350 male infants born every year. Some of the negative effects of hypospadias include:
* Trouble directing urine stream (especially in severe cases)
* Fertility problems
* Painful or awkward curve during erection
* Psychosocial impact (e.g., embarrassment every time the boy needs to go to the washroom with other children or adult present)
Different Types of Hypospadias
The type/severity of hypospadias present in a male child is dependent on where the opening of the urethra is located. The types of hypospadias are distal (glanular and subcoronal); middle (distal penile, midshaft, and proximal penile); and proximal (penoscrotal, scrotal, and perineal).
Distal- the opening of the urethra is located underneath the glans itself (glanular) or near the head of the penis (subcoronal).
Middle – the opening of the urethra is located anywhere on the underside of the penile shaft (distal penile, midshaft, or proximal penile.
Proximal- the opening of the urethra is located in the narrow area between the penis and the scrotum (penoscrotal). It can also be located in the scrotum itself or even in the perineum (the area between the scrotum and the anus). This is the most severe form of hypospadias.
Signs that a Newborn Has Hypospadias
This birth defect can be easily detected as soon as the infant is born. Apart from an abnormal opening of the urethra, some of the signs of hypospadias include:
– Urine is discharged from the underside of the penis, the scrotum, or perineum.
– The penis is curved or bent downward (chordee).
– The dorsal hood (foreskin) is located at the top of and does not adequately cover the glans of the penis.
What Should Parents Do About It?
Surgery is not required if the case is very mild and your pediatric surgeon deems that the defect will not have a negative effect on your child’s psychosocial well-being.
If your child is diagnosed with hypospadias, refrain from having the child circumcised as the foreskin will be used later on during surgery (if required due to the severity of the case).
Although this birth defect is pretty common among boys, parents should consult with their pediatrician on the best course to take the moment their child is diagnosed with hypospadias. They will be then referred to a pediatric surgeon who specialises in hypospadias.
The ideal age for reconstructive surgery for children diagnosed with hypospadias is between 6 to 18 months old. This is done to minimize the negative psychological impact on the child. There are cases when the child needs to undergo more than one surgical procedure. The number of medical procedures the child needs to undergo depends on the severity and complexity of the case.
What to Expect During, and After Surgery?
The child will be under general anesthesia before surgery. During surgery, the surgeon will take a piece of the foreskin (or any other tissue from another part of the child’s body) and graft it to the urethra. The opening of this corrected urethra will now be shifted to its proper position at the tip of the penis. The original hole at the underside of the penile shaft will be closed over afterward.
The curvature of the penis will also be corrected during surgery to ensure proper urinary stream. The bend is also straightened to ensure that future intercourse will not be painful or difficult.
Babies with mild hypospadias will be allowed to go home after the procedure. Those who have severe forms of hypospadias, however, will need to be hospitalized after the procedure. The surgeon may place a stent or catheter in the urethra to ensure that it will hold its shape and allow the proper passage of urine while the wound heals. The tube will be removed between 2 to 7 days after the surgery. The child may experience swelling in the groin area.
Although the success rate of hypospadias procedure is high and your child’s surgeon will ensure that the procedure will go as planned, there are still some complications associated with this corrective surgery. Listed below are some of the complications associated with hypospadias repair. (Note that not all complications are cause for alarm, but talk to your pediatric surgeon if you notice that your child experiences the following.)
* Urine leaking from the wound (fistula). This is possible when the surgical wound fails to heal properly.
* Blood clot or haematoma
* Bleeding
* Constriction or narrowing of the corrected urethra
* The bend may not be corrected properly even after corrective surgery.
Caring for Your Child After Surgery
If your child comes home with a catheter or stent in his urethra, remember that it may later cause bladder spasms while the child is sleeping. Though perfectly normal, bladder spasms are uncomfortable and you may see a drop of blood in the diaper when this happens. Contact the clinic or hospital immediately if the bleeding becomes profuse.
After surgery, your son’s penis will be dressed with a waterproof dressing to protect the wound from dirt, germs, and moisture. If this dressing comes into contact with your son’s stool, simply clean it with tepid and soapy water away from the wound and toward the child’s rectum. Remove the dressing in the bath 48 hours after the surgery. Make sure that your hands are clean, and be mindful of the catheter if you are removing the dressing.
While the dressing is still in place, it is best that you give your son a sponge bath. You can give the baby the usual tub bath (using tepid water minus the soap) 48 hours after the surgery. Refrain from scrubbing the groin area or washing the penis directly. Using a towel, gently pat the area until dry.
Ensure that your son’s fluid intake is adequate after the surgery to help them pass urine often and to prevent constipation. If your son does not like to drink water, substitute it with juice, soups, or sweet frozen treats. Make sure that your child also eats high-fiber foods to prevent constipation.
While the wound is still healing, ensure that your child refrains from strenuous play and other activities. This will not be a problem for infants, but it can be an issue for normally active toddlers. Allow them to solve jigsaw puzzles and play board games or games on the iPad while the wound is healing.
For any further information on the topics, please get in touch with Children Surgery on 1300 375 455 or via email at enquiries@childrensurgery.com.au