In many boys with hypospadias there is also a downward bend on the penis noticed especially on erection. The foreskin is also affected being hooded on the top of the penis rather than wrapped all around the tip.
Hypospadias is very common affecting 1 in 300 boys. The exact cause is unknown. The penis develops in the foetus between 6 and 12 weeks, often before you know you are pregnant. External factors do not appear to influence its development in any way. Occasionally, but not usually, it will be passed on in families. When properly corrected it does not cause long-term problems with passing urine or sexual function. A natural appearance is usually restored.
What does this condition involve?
In 70% of hypospadias cases, the abnormality is mild, with the urethral opening only marginally misplaced near the tip of the penis.
In 30% of cases, however, hypospadias can be more serious, with the urethra opening on the shaft or at the base of the penis. The penis will be noticed to look unusual at birth or soon after. There is no urgency to treat this condition, but once recognised you will be referred to a specialist to discuss surgery to correct the problem.
The images below show on the left, a case of mild hypospadias, where the opening of the urethra is on the undersurface of the penis but quite near the tip. On the right, a more severe case is shown, where the opening is near the base of the penis. The issues on the undersurface are all underdeveloped and tight. The penis is likely to be bent downward when erect
What surgery is available, and what techniques are involved?
Surgery is recommended to make the penis look as natural as possible and to enable the child to stand up to pass urine. Corrective surgery for the treatment of hypospadias is often carried out 12 months after birth but can be done earlier or later. Both paediatric urologists and plastic surgeons treat this condition and which you see will depend on the arrangements in your area. Both types of Specialist use similar techniques and would expect to achieve similar results. Operations usually last one-and-a-half to two hours and are carried out under general anaesthetic. During the operation, the surgeon will aim to relocate the urinary meatus, straighten the penis where necessary and achieve a symmetrical rearrangement of the skin.
This diagram shows the operative sequence in repair of hypospadias. There is a groove in the undersurface of the tip of the penis. Sometimes this groove is incised to make it deeper. In two-stage repairs the groove has been created using a skin graft that was inserted at the first stage 6 months earlier. The groove is then tubularised around a catheter. The tip of the penis is then sewn together, and the skin rearranged. In this case the foreskin has been reconstructed.
In most boys with relatively mild hypospadias correction is achieved in a single operation. More severe hypospadias might need more than one operation to achieve a satisfactory result. Using local flaps and skin grafts, the surgeon rearranges soft tissue to reconstruct the urinary meatus and rebuild the urethra so that it extends all the way to the tip of the penis.
Is this surgery available on the NHS?
Surgery to correct hypospadias is widely available on the NHS.
Who will my child see?
As a patient with hypospadias, your child will be seen by a multi-disciplinary team. This team will be made up of specialists working together to make sure that the best possible treatment is given. These specialists may include the following:
• Plastic surgeon
• Paediatric urologist
What should I expect in terms of treatment, procedures and outcomes?
Surgery for hypospadias is done either as a day case or with a brief hospital stay. The penis will often look quite swollen and bruised initially, but this soon settles down. Often a tube or catheter will be passed in the bladder to drain urine and protect the repair. This will remain in place for a few days after the operation. Most operations to correct hypospadias are very successful. Surgeons have perfected the techniques involved and are able to restore normal urinary function and appearance. This function is usually restored for the rest of a patient’s life, but very occasionally problems can arise that will require further surgery. As with any operation there is a slight risk of bleeding or infection after the surgery, but these are not usually too much of a problem.
Specific to hypospadias there is a risk that the boy might develop a leak between where the urethral opening was and its new position. If this occurs a further operation will be needed to correct it. Also there is a slight risk that the newly built urethra might get narrow, again more surgery might be needed to deal with this. Everything will be done to minimise these risks
Great Ormond Street Hospital for Children