Hypospadias

HYPOSPADIAS

Hypospadias is a congenital malformation of the male genitalia, mainly characterised by the incomplete development of the urethra. It is an abnormal opening of the urethra, not at the tip of the glans, but on the ventral surfaces on the penis. The foreskin of the penis (prepuce), which normally covers the glans, is absent on the ventral part of the penis and is visible on the dorsal part. This abnormal opening of the urethra can be located at any level, along the penis, on the scrotum or on the perineum. Hypospadias can be associated with a curvature of the penis (congenital curvature) while erect.

The classification of hypospadias is based on the location of the urinary meatus:

 

  • glanular – subcoronal (distal) 50% of cases
  • penile (medium) 20% of cases
  • scrotal-perineal (proximal) 30% of cases

 

The urinary meatus in an abnormal location creates different problems, including deviation of the urinary stream, altered aesthetic appearance of the penis and genitalia, and psychological issues with potential repercussions for the patient's quality of life.

What is the incidence of hypospadias and associated abnormalities?

Hypospadias is present in about 0.3% of healthy male newborns. The abnormalities of the urinary tract in patients with hypospadias are rare because the external genitals are formed after the high urinary tract. An undescended testis and hernias of the groin are the most frequent pathological conditions (10% of cases) associated with hypospadas. In scrotal-perineal forms of hypospadias, there can be complex anogenital malformations and chromosomal disorders.

Diagnoses of hypospadias can be made in utero during pregnancy, using ultrasound tests on the fetus. In any case, the confirmed diagnosis is immediate at birth. Classic signs of a penis with hypospadias are the abnormal position of the urinary meatus and the presence of the typical foreskin hood on the back of the penis.

 

What surgical treatments can cure this problem?

There are mainly three motives that can lead to surgery:

  • Functional motive:

The meatus in an abnormal location prevents urination while standing.

If the meatus is narrow, urination is not possible, leading to problems in the bladder and kidneys

  • Sexual motive:

In the future, the possible presence of congenital curvature of the penis will hinder the penetration of the penis in the vagina.

In severe cases, the abnormal position of the meatus will prevent ejaculation in the vagina, and will therefore make it difficult to make a woman pregnant.

  • Aesthetic motive:

The appearance of the penis can cause significant psychological problems.

 

Surgical intervention can provide an answer to all three motives of functionality, sexuality and aesthetics:

  1. Put the urethral meatus in its natural position at the tip of the penis and reconstruct the missing urethra
  2. Correct the curvature of the penis
  3. Create an aesthetic appearance resembling a typical penis

 

The best time for surgical correction of hypospadias is between the 6th and 18th month of life, when the psychological consequences of a surgical intervention are minimal.

 

Determining the long-term value of the results in patients who undergo surgery for hypospadias is difficult, and often the value of the results on the part of the surgeon is different than that of the patient. All patients, then, should be monitored throughout adolescence and should be offered the possibility of another aesthetic correction if they are not satisfied. In any case, with today's surgical techniques, a patient born with hypospadias has a greater possibility of normal sexual function, normal size and an acceptable aesthetic result.

 

Complications of Hypospadias

Hypospadias surgery is characterised by a 10-30 % rate of complications--mostly fistulas and urethral strictures--that can require further restorative surgery at least three months from the first procedure.

Complication: Urethral Fistula

urethral fistula complication
surgery for urethral fistula complication
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