1. What is hypospadias and what causes it?
Hypospadias is a genital atypia in which the urethral outlet is located lower than usual (in the ventral portion of the penis). It is commonly associated with excess skin of the foreskin on the back of the penis (dorsal region). In hypospadias, it is relatively common for the penis to be curved forward when erect.
The cause of hypospadias is not yet fully understood. It is known that the genitalia is formed by the transformation of testosterone into dihydrotestosterone. The lack of action of this hormone may be the cause of this condition. As it is usually an isolated event, occurring only during pregnancy, there will normally be no hormonal changes in the future.
2. Is hypospadias associated with any syndrome that I need to worry about?
There are more than 100 syndromes associated with hypospadias, but usually hypospadias is an isolated condition and no tests are needed to check for other unsuspected organic diseases.
3. Should I correct my son's hypospadias?
Hypospadias should be corrected whenever there are functional alterations, i.e. when the urethra is so low that there is a risk that ejaculate or urine won't come out properly and the man has infertility or can't urinate standing up. Also when there is curvature, there is a need for correction due to the risk of difficulty in penetration in the future. When the hypospadias is more distal, i.e. closer to the tip of the penis, correction is optional. However, there are studies that show that this penile atypia can cause psychological discomfort and interfere with the individual's self-image. For this reason, our opinion is that atypia merits correction in the vast majority of cases.
4. Is all hypospadias the same?
No. When hypospadias can be close to the glans (head of the penis) they are called distal, when they are in the middle of the phallus they are called mediopenial and when they are close to the scrotum they are called proximal. The more proximal, the greater the chance of surgical complications. Surgical techniques also change according to the location of the urethra. Another important aspect to consider is penile curvature, which must be corrected during surgery. The correction technique will depend on the extent of the penile curvature.
5. How long will the surgery take?
This will depend on the type of hypospadias. The more proximal ones, with extensive penile curvature, are usually corrected in two stages. However, there are proponents of one-stage correction. In my opinion, two-stage surgery has the advantage of better aesthetic results and complications arising from surgery are easier to treat. The vast majority of cases, however, can be treated in a single operation.
6. What is the rate of surgical complications?
Hypospadias surgery is complex and should be performed by someone who has experience with the procedure. In addition, the delicate surgical material and the use of magnifying glasses help to improve the results. It varies according to the type of hypospadias, with the more proximal ones being the most complicated. The most common are urinary fistula (urine leak), diverticula and urethral stenosis. The surgeon's greater experience will reduce these rates to a minimum. Talk to your doctor about this.
7. Can the surgery be performed in a day hospital?
Yes, most of the time
8. Will there be a need for a probe?
Usually yes, for 5 to 14 days depending on the situation and the doctor's preference
9. How does the penis look?
The intention is to leave the penis looking as similar as possible to a phimosis-operated penis. We leave the penis circumcised, i.e. with no skin covering it. There is the possibility of reconstructing the foreskin, but there is a greater risk of reoperation due to excessive scarring and narrowing of the skin