Hypospadias is an anomaly that affects the male urinary and genital system. The surgeon's experience is fundamental in reducing surgical complications
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Hypospadias is a congenital condition that affects the male urinary and genital system. In it, the opening of the urethra, the channel that carries urine from the bladder out of the body, is not located at the tip of the penis, as is common, but in another position further down the shaft of the organ.
Normally, the urethra opens at the tip of the penis, but in cases of hypospadias, it can be located at the bottom of the penis, in the region of the scrotum or somewhere in between.
The severity of hypospadias can vary, from mild forms in which the opening is only slightly displaced, to more severe forms in which the opening can be close to the base of the penis.
In this article, we'll cover everything you need to know, from the importance of age for early surgery to advanced techniques and post-operative care. Read on and check it out.
What is hypospadias?
Hypospadias is a common congenital malformation in newborn boys, characterized by the anomalous opening of the urethra at the bottom of the penis. The opening of the urethra, where the pee comes out, is below the penis. The urethral canal needs to be corrected so that the urine flow is directed towards the glans.
Head of urethral reconstructive surgery for children and adults at the Federal University of Bahia Hospital, Dr. Ubirajara Barroso Jr. points out that the incidence of hypospadias varies between 3 and 8 cases per 1000 live births. He also points out that when a child is born with hypospadias, there is a chance that another member will be born with the same condition in 20% of cases.
Hypospadias is classified into different types based on the location of the urethral opening. See:
- Glaandar:
In this situation, the urethral meatus is born at the base of the glans. "It's the mildest form of hypospadias," explains the surgeon.
- Subcoronal:
In this type, the urethral meatus opens just below the glans (head of the penis). "It's considered a mild case of hypospadias," says the urologist.
- Middle-Pennine:
In the case of mid-penile hypospadias, the urethral meatus opens into the body of the penis, between the glans and the base. "This is a moderate type of hypospadias," says the specialist.
- Proximal or Lower Penile:
In proximal hypospadias, the meatus is located in the lower part of the penis, closer to the base. "This is considered a more serious type of hypospadias," he says.
- Scrotal:
Scrotal hypospadias involves the urethral meatus opening into the scrotum, the sac containing the testicles. "This is a more severe and less common type of hypospadias," he points out.
- Perineal:
The perineal type is the most serious, with the urethral meatus opening in the region between the scrotum and the anus (perineum). "In scrotal and perineal hypospadias, peno-scrotal transposition is common. This is an alteration where the root of the scrotum rises above the penis and can resemble the labia majora," he explains.
Classifying the types of hypospadias is fundamental to determining the most appropriate treatment plan. "Each case is unique, and the choice of surgical approach depends on the severity of the condition and the location of the urethral meatus," says Dr. Barroso.
Treatment for hypospadias usually involves surgery aimed at correcting the anatomy to allow proper urinary and sexual function, as well as improving genital aesthetics.
Surgical intervention is often recommended at a younger age to avoid future complications and allow the genital organ to develop normally.
When to have surgery to correct hypospadias
According to Dr. Ubirajara Barroso, the decision to perform hypospadias surgery at a younger age, between 6 months and 1 year old, is important. "Waiting until adulthood can increase surgical complications. Furthermore, surgical complications also have to do with the severity of the hypospadias and the surgeon's experience," explains the urologist.
The doctor emphasizes that it is more advisable for the surgery to take place up to one and a half years of age, in order to guarantee a lower psychological impact on the children and a better functional result with a lower complication rate.
"Hypospadiologists are surgeons who specialize in correcting hypospadias. They have a specific approach that reduces risks and improves the results of surgery. The surgeon's experience plays a vital role in reducing surgical complications," he adds.
Each patient is treated according to the severity of their condition, however, all correction of this anatomical defect is carried out by surgery. "The most common hypospadias, in over 90% of cases, can be repaired in a single operation. Other types may require surgery in two stages," explains the urologist.
Dr. Barroso adds that in cases where more than one surgical intervention is necessary, the interval should be 6 months between one procedure and the next.
Advanced techniques for hypospadias surgery
The surgical outcome of hypospadias is closely related to the surgeon's experience. Currently, Dr. Ubirajara Barroso Jr.'s team has developed a technique to further improve surgical results.
In the hands of inexperienced doctors, hypospadias surgery may require correction or, in more serious hypospadias, the use of grafts may be necessary.
The inverted "U" technique is an advanced approach used in challenging cases. This technique reduces graft retraction, which is of great importance for urethral reconstruction.
"This technique consists of removing mucosal tissue from the inside of the mouth in a 'U' shape, doubling the amount of graft for the surgery, which contributes to better results and better efficacy in the treatment of hypospadias," he describes.
Use of the hyperbaric chamber after hypospadias surgery
According to Dr. Ubirajara, some studies show the benefits of hyperbaric oxygen therapy in the post-surgical recovery of hypospadias. Hyperbaric therapy brings benefits such as
- Increased tissue oxygenation;
- Reduced complications;
- Improved graft adherence;
- Reduced graft contraction;
- Exploration of treatment protocols for different cases, including pre- and post-surgery
"It can be used after surgery and in some cases before and after the surgical procedure. For patients who have not yet undergone surgery, 10 sessions can be offered in the post-operative period, for patients who are going to undergo a second intervention, 10 sessions are offered before surgery and 20 sessions afterwards. In multi-operated patients, hyperbaric sessions are carried out 1 month before and 1 month after surgery."
Complications and post-operative period of hypospadias surgery
In addition to the anomalous opening of the urethra at the bottom of the penis, hypospadias can be associated with penile curvature which results in fibrous tissue pulling the penis downwards during erection. This correction is also carried out during hypospadias surgery.
In some cases possible complications can occur, such as urethral stenosis (obstruction of the channel through which urine passes), urine leakage (fistula), urethral dehiscence (loss of what has been done), persistence of penile curvature and urethral diverticulum.
Post-operative care is very important for the effectiveness of the surgical intervention, including adequate hydration of grafts, which is essential for minimizing risks and optimizing recovery.
"Except for glandular hypospadias, we leave a tube in the urethra for 5 to 14 days in the post-operative period, depending on the type of surgery, and the patient is discharged the same day or the next day," says Dr. Ubirajara Barroso Jr.
In the quest to correct penile curvature, the specialist stresses the need to be careful when exploring the size of the penis to the maximum. "Generally, it is at the lower end in terms of size, seeking an increase in the length of the phallus to reach the average. It's important to carefully consider the genital dimensions."
This is usually a common complaint in adulthood, and Dr. Barroso points out that when correcting it, it is necessary to lengthen the penis during the procedure. "Conventional treatment for hypospadias includes penile lengthening surgery. When hypospadias is corrected, it is necessary to lengthen the penis during the correction itself," he concludes.
Hypospadias can be identified as soon as the baby is born. Here are some signs that may indicate the presence of hypospadias in a newborn:
- Position of the urethra;
- Urine stream pattern;
- Anomalies in the head of the penis;
- Penile curvature;
- Difficulty urinating.
Confirmation of the diagnosis should be made by a health professional, especially a pediatrician or pediatric urologist. Early diagnosis can be fundamental for proper treatment and better long-term results.
If you suspect hypospadias in your child, make an appointment for a detailed assessment and advice on treatment, if necessary.
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