Hypospadias is a birth defect in male babies where the opening to the urethra is located under the penis. Find out how to treat this condition.
Hypospadias is a birth defect in male babies in which the opening to the urethra, which is the tube that carries urine from the bladder out of the body, is located under the penis rather than at its tip . Depending on where exactly it is located, this condition can vary in severity. In addition to impacting the appearance of the penis, this abnormal urethral opening can lead to difficulty urinating in babies. This illness can have other psychological and emotional consequences on children as they grow up. Early diagnosis and treatment are crucial in treating cases of this birth defect. In most cases, the pathology requires surgical correction. Although this condition can be difficult for babies and their families, it is important to remember that hypospadias can be treated successfully and most children with this condition grow up to lead normal, healthy lives.
What is hypospadias?
Hypospadias is a birth defect in male children where the urinary opening is on the undersurface of the penis, instead of at the tip. It is usually associated with a downward curvature of the penis, called Chordee. It is a common condition of varying severity that occurs in approximately 1 in 200 male children.
However, most often this is an isolated defect with no other major systemic problems. But in some cases, it can be associated with disorders of sexual development (DSD), hormonal, endocrine or genetic. The presence of undescended testes, a severe form of the disease and other systemic signs should alert to this possibility.
Types of hypospadias
Here are the main types of pathologies, depending on the location of the urethral opening:
- Glanular: Here the urethral opening is located on the head of the penis, but not at its tip. This is the mildest form of the disease.
- Coronary: In this case, the urethral opening is located just below the head of the penis, where the head meets the shaft.
- Subcoronal: Here the urethral opening is located slightly further into the shaft of the penis.
- Intermediate shaft: In this variant of hypospadias, the urethral opening is located in the middle of the penile shaft.
- Penoscrotal: When the urethral opening is located where the penis joins the scrotum, it is called penoscrotal hypospadias.
- Scrotal: In this case, the urethral orifice is located on the scrotum.
- Perineal: Most serious form, where the urethral opening is located on the perineum (the area between the scrotum and anus).
Is hypospadias a serious problem?
Yes, untreated hypospadias will lead to problems with urinary stream, penile curvature, erectile dysfunction, painful erection, apparently small penis size and inability to have normal sexual relations. This is true even with some of the milder varieties of the disease.
Treatment of hypospadias
Any child with abnormal (ambiguous) genitalia at birth should receive immediate medical attention, as this could even be part of life-threatening hormonal disorders and also help determine the child’s true sex. If other medical problems are excluded and a diagnosis of isolated hypospadias in a male child is established, only elective treatment is necessary. Even seemingly milder varieties of the condition require surgical correction, due to the associated penile curvature and abnormal penile skin. Patients with milder forms of the disease usually undergo a single-stage surgery (called urethroplasty), while severe forms undergo surgery in stages. The ideal time for surgery is around 1 year of age.
The second stage, when necessary, is carried out approximately 6 months later. Some children may require preoperative hormonal treatment. Complications associated with surgery increase as the child grows. Additionally, the technical aspects of performing the surgery (in expert hands), wound healing, and postoperative management are much easier in late infancy. The mental distress of the child and their caregivers, when operating at a later age, is much greater. Uncorrected hypospadias is also found to be associated with severe mental anguish and social/peer group problems in older children and their parents.

Therefore, the key to the best possible outcome lies in performing the right surgery, at the right age and in the right hands. With the advent of better sutures and instruments, a better understanding of anatomy, and specialization in hypospadias surgery, the results are significantly better than in previous times.
Treatment of untreated hypospadias in older children
Even in an older patient, surgical intervention is possible with good postoperative results, provided that the appropriate surgical correction is performed by expert hands. Detailed preoperative planning, use of advanced surgical techniques, interdepartmental collaboration, and ensuring patient cooperation are the keys to success in this scenario. Appropriate education, psychological support and counseling are necessary for the patient and their family.
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