Health Topics: Hypospadias

Hypospadias is the medical name used to describe a urine channel which ends under the tip of the penis. During pregnancy, the urine channel starts developing as a groove between two ridges. The ridges grow and fuse together on the under side of the penis to make a tube. This tube closes from behind the scrotum (the sac holding the testicles) out to the tip of the penis. As it forms, the tube leaves a little line on the skin which you can see on the scrotum and the penis. If the closing over of the tube stops before it reaches the end of the penis, hypospadias results.

What causes hypospadias?

No one knows exactly what causes hypospadias, but we do know that it is not caused by anything either parent did during or before the pregnancy. Hypospadias can occur in some family lines. However, in most cases, it is not inherited.

How is hypospadias treated?

If the urine channel almost reached the end of the penis, we can usually move the opening out to the tip without actually making the channel longer.
If there is more than 1/4 inch between the end of the urine channel and the tip of the penis, or if the penis is curved or bent downward (a condition called chordee) the urine channel will need to be lengthened. This can be done surgically by using some of the foreskin, some of the skin on the underside of the penis or skin from another area.

Are there any complications with this surgery?

There are potential complications with any medical treatment. In hypospadias surgery the most common complications are:

• fistula

• stricture

Fistula is a leak point between the new urine channel and the skin of the penis. This would usually show up one to six weeks following surgery. The chance of a fistula depends on the type of surgery used. If a fistula develops a second, shorter surgery may be necessary. In the most severe case, a fistula could result in the opening up of the entire urine channel. Fortunately, this is very rare.

Stricture is a tight spot somewhere along the urine channel. This most often occurs at the tip of the penis or at the beginning of the new urine channel. The chance of a stricture developing depends on the type of surgery used. If a stricture develops a second, shorter surgery may be necessary.

Other less common complications could occur such as infection, bleeding, or skin rash.

Is the surgery safe?

Yes! Almost all boys with hypospadias can have their surgery as an outpatient. This means that the child comes in to the outpatient surgery center in the morning, has the surgery and is ready to go home by early afternoon. This surgery is performed under general anesthesia. Local anesthesia would be terrifying to a child and it also would make the surgery very difficult. Loyola has well-trained pediatric anesthesiologists who have had special training in the care of children. They use continuous oxygen, heart and blood pressure monitoring to make sure that the anesthesia is safe.

Is there anything I can do to prepare my child for surgery?

Infants do very well with surgery. Children who are old enough to talk are sometimes anxious if they don't know what will happen to them. You can ease this fear by talking about the upcoming surgery. Many local libraries have books or video tapes about going to the hospital or doctor's office. We also have a video tape which can explain the Outpatient Surgery Center to children. Children are often fearful of an unfamiliar environment. It may help to bring a favorite toy or blanket on the day of surgery.

Like children, parents also are sometimes anxious about the unknown. Don't hesitate to ask questions. We want you to have all of the information you need about your child's care. It may help to write down questions as you think about them. Bring them with you to your child's appointment and we will be happy to answer them.

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