What is it and what is its impact?
Hypospadias is a relatively common birth defect found in boys, in which the urethra opens at the bottom of the penis, instead of at the tip. Penile curvature can be associated with this type of problem and results from a fibrous tissue that pulls the penis down during erection, which is called chordee. Its incidence is around 3 to 8 per 1000 live births. There is some risk of familial transmission. When a son has hypospadias, there is a chance that another member will be involved in 20% of cases.
Hypospadias varies according to degree. In mild cases, the meatus opens on or just below the glans (subbcoronal). In moderate cases, the meatus opens in the body of the penis (median penile). In severe cases, the meatus is at the base of the penis (proximal hypospadias). There are even more severe cases where the meatus opens into the scrotum or perineum (between the scrotum and anus).
What causes hypospadias?
The cause of hypospadias is not known. However, it appears to be the result of a failure or delay in the production of testosterone in the fetus. This is not usually associated with a specific condition, but it can be related to a deficiency of the testicles in hormone production or to other disorders of sexual differentiation, such as 5-alpha-reductase deficiency.
What are the reasons for surgical correction?
When the urethral canal ends at the base of the penis, often in adulthood, the ejaculate may not follow the intravaginal route due to the atopic position of the urethral canal, leading to infertility. In addition, many cases are associated with penile curvature, which can make vaginal penetration difficult in the future. The child may also have psychological changes caused by self-image problems since the penis does not look normal and many children, in the most severe cases, have to urinate sitting down.
What is surgical correction like?
The surgery is usually carried out on an outpatient basis, meaning that the child is discharged from hospital on the same day. The surgery consists of correcting the urethra, redoing the anatomical glans-urethra relationship so that the glans covers the urethra and finally correcting the penile curvature, if present.
What are the surgical complications?
Hypospadias surgery, in inexperienced hands, can have disastrous results. Hence the need to have this problem corrected by someone with experience in this type of procedure.
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