Hypospadias is a congenital malformation of the urethra and is one of the most common penile malformations in male newborns. In hypospadias, the urethral opening is not located in its usual position on the glans, but further down on the underside of the penis.
The term “hypospadias” describes various forms and degrees of severity, ranging from distal to proximal hypospadias. In addition to the displaced urethral opening, changes in the foreskin or penile curvature often occur. The diagnosis is usually made in newborn boys immediately after birth.
Depending on the severity of the hypospadias, surgical correction may be recommended. The goal of treatment is to achieve the best possible outcome, both functionally and cosmetically. Modern techniques in pediatric surgery and urology now enable very good treatment outcomes.
What are the different types of hypospadias?
Hypospadias can be classified into three different types:
- Anterior hypospadias: The urethra opens on the underside of the glans (approximately 70% of those affected by hypospadias)
- Medial hypospadias: The urethra opens in the middle of the shaft of the penis
- Posterior hypospadias: The opening of the urethra is located in the perineal region or on the scrotum
Symptoms of hypospadias
Hypospadias is typically accompanied by a cleft foreskin, in which the foreskin does not completely cover the glans.
Due to the shortened urethra, the penis is often curved downward. In some cases, this curvature is further accentuated by a connective-tissue-like cord.
What causes hypospadias?
Hypospadias is caused by a developmental abnormality of the urethra during the embryonic period.
The causes and risk factors for this malformation remain largely unknown to this day. Hypospadias occurs more frequently in some families. Therefore, it is assumed that genetic factors may be responsible for its development.
In hypospadias, the male urethra is shortened. Normally, it ends at the tip of the glans © SciePro | AdobeStock
Surgical Treatment of Hypospadias
The gold standard for treatment is surgical correction. It should be performed by an experienced urologist or pediatric surgeon. Ideally, this surgical procedure is performed during early childhood (12 to 18 months). However, correction is also possible in adulthood.
The goal of surgical correction is to relocate the urethral opening to the tip of the glans. This requires lengthening the shortened urethra. Ultimately, the surgery also aims to correct any curvature of the penis.
The procedure is relatively complex and should therefore be performed by an experienced urologist. It is usually performed under general anesthesia. The surgery takes between one and four hours, depending on the individual’s anatomical conditions. In particularly complex cases, the surgery may take longer.
If the hypospadias is only mild, surgical correction can sometimes be performed on an outpatient basis.
Before the surgery, the treating physician informs the patient about possible risks, such as
- postoperative bleeding,
- swelling, and
- wound infections
. As with all surgical procedures performed under general anesthesia, there is also the usual risk associated with anesthesia.
What surgical procedures are available for hypospadias?
Depending on the severity of the hypospadias, various surgical methods may be used. After an examination by a urologist, the urologist will discuss the planned surgical method with the patient.
Because of the variety of surgical techniques, it is important to have the hypospadias evaluated by a specialist, as each case of hypospadias must be treated individually. It is also important for the treating specialist to know whether penile curvature is present. Congenital penile curvature very often occurs alongside hypospadias. In such cases, the hypospadias surgery should be performed in combination with a correction of the penile curvature.
The more
- more pronounced the penile curvature is and
- the further back the opening of the urethra is located.
For example, in some cases, a partial reconstruction of the urethra is performed. Parts of the oral mucosa or the foreskin are used as autologous grafts for this purpose.
In particularly severe cases of hypospadias, a single procedure is not sufficient. In such cases, multiple surgeries are necessary to achieve a satisfactory result.
The Post-Treatment Process
The urinary catheter inserted during the surgical procedure must remain in place for between two and twelve days, depending on the severity of the hypospadias. This is intended to help the newly formed urethra heal properly and prevent the formation of fistulas.
After a successful hypospadias correction, the patient should visit his surgeon regularly for follow-up appointments, as potential problems (e.g., fistulas and strictures in the urethra) can arise even years after the surgery.
Hypospadias Specialists – Training and Continuing Education
It is important to know that hypospadias should only be treated by specialists. This may be a urologist, a surgeon, or a pediatric surgeon. However, not every specialist in pediatric surgery or urology is qualified to perform such complex surgeries. Appropriate specialization is required for this.
FAQ
What is hypospadias?
Hypospadias is a congenital malformation of the urethra in which the urethral opening is not located at the tip of the glans. Instead, the meatus is located on the underside of the penis. The malformation of the penis can vary in severity and is classified into distal and proximal forms.
What are the symptoms of hypospadias?
Symptoms of hypospadias include a malpositioned urethral opening, a prepuce flap, penile curvature, and abnormalities during urination. Depending on the severity of the hypospadias, the malformation may have functional or cosmetic implications. The changes are often more pronounced, particularly in cases of proximal hypospadias.
When should surgery be performed?
Surgical correction is usually performed during childhood, often between the sixth and eighteenth months of life. The goal of the surgery is to correct the hypospadias, straighten any chordae, and relocate the urethral opening to the tip of the glans. The choice of surgical procedure depends on the severity and the anatomy of the penile shaft.
What complications can occur after hypospadias surgery?
As with any surgical procedure, complications can occur. These include fistula formation, scarring, recurrent urethral stricture, or cosmetically unsatisfactory results. However, the complication rate is low when performed by experienced surgeons. A catheter is often inserted postoperatively to aid tissue healing.
Can hypospadias also affect adults?
Yes, although the condition is usually diagnosed in newborns, adult patients with untreated hypospadias or a history of previous surgeries may also need to be evaluated by a urologist. This applies in particular to recurring symptoms, curvature, erectile dysfunction, or corrections following previous hypospadias surgeries. In such cases, reconstruction, free grafts, or urethral plasty may be necessary.
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