Hypospadias is a congenital disorder that can be seen in newborn boys. In a normal penis, the urethra terminates at the tip of the glans, and children urinate from the tip of the penis.

In children with hypospadias, the urethra terminates on the underside of the penis and further back. The urethra is not formed in the space between this termination point and the tip of the penis.

The opening of the urethra may even be further back than the testicles, and the further back it is, the more serious the condition. However, the majority of cases are closer to the tip of the penis.

What are the symptoms?

1) The urethra is located on the underside of the penis and further back.

2) Flattening of the glans penis.

3) Absence of the foreskin (prepuce) on the underside of the glans penis (congenital partial circumcision).

4) The penis curls downwards during erection.

5) Children with hypospadias cannot urinate straight ahead; instead, they urinate towards their feet. This situation necessitates urinating while sitting (instead of urinating while standing).

6) In individuals with a very posterior urethral opening, if not surgically treated by adulthood, it can lead to sexual dysfunction.

When Does it Occur?

Fetal (in the womb) sex differentiation occurs during the first three months of pregnancy. A developmental abnormality in this organ during this period results in the urethra (urinary tract) not forming completely before it stops, leading to hypospadias.

The exact cause of this developmental abnormality is unknown. A decrease in androgenic (male) hormone stimulation or certain hereditary factors are implicated.

The fact that a male baby born to a family with a child with hypospadias has a probability of developing hypospadias exceeding 20% ​​highlights the importance of hereditary causes.

Types of hypospadias according to the point where the urethra (urinary tract) opens

How is it diagnosed?

Today, it is possible to diagnose the condition prenatally using ultrasound during pregnancy. If this is not possible, diagnosis can be easily made with a clinical examination from birth. Rarely, in children with hypospadias, the prepuce (foreskin) may be normal and complete. In these cases, hypospadias near the foreskin may not be retracted. It may not be detectable.

How Common Is It?

It occurs in approximately “1 in 300 male births”.

What Other Tests Should Be Done?

Another common congenital problem associated with hypospadias is undescended testicles and inguinal hernia. Therefore, it is essential to check whether children with hypospadias have testicles and whether they have descended into the scrotum.

Also, hypospadias cases can occur as part of very rare gender differentiation problems (hermaphroditism). Therefore, gender differentiation tests (chromosome analysis, etc.) should be performed in suspected cases.

Treatment

The only treatment is surgery. In the operation, the fibrotic band called chordee, which causes the penis to curve downwards, is removed, and the penis is straightened so that it does not curve downwards when erect.

A new urethra is created to complete the missing section from the opening of the urethra to the tip of the penis. The flattened glans penis is then corrected. The glans is given its natural conical shape. In short, the result is a penis shape that is aesthetically and functionally acceptable.

The operation utilizes very fine and delicate techniques of Plastic, Reconstructive, and Aesthetic Surgery. For the surgical procedure to be successful, it must be performed by individuals with Plastic, Reconstructive, and Aesthetic Surgery licenses and, in particular, sufficient knowledge and experience in this field.

There are different methods to choose from depending on the type of hypospadias. The surgical procedure can last between 1 and 4 hours, depending on the chosen method.

Should Circumcision Be Performed?

In many types of hypospadias, the foreskin (prepuce) is used to create the missing urethra; therefore, this valuable material should not be wasted by circumcision. In other words, circumcision should not be performed!

How Long Will the Patient Stay in the Hospital?

The hospital stay varies between 3 and 10 days depending on the severity of the hypospadias and the method used.

What are the Surgical Outcomes?

Following surgery, most children achieve normal function and a good cosmetic outcome. On average, problems are resolved with a single operation in 90% of children with hypospadias. However, when these operations are performed without adhering to the principles of Plastic, Reconstructive and Aesthetic Surgery and by unqualified individuals, the complication and failure rate is significantly reduced.

What about Reproductive Function?

Unless there is infertility due to another reason, such a problem is not expected in children with hypospadias. A successful operation does not have a negative impact in this regard.

Is there a Psychological Impact?

Repeated operations that are unsuccessful each time can negatively affect the individual psychologically. Therefore, a successful outcome with a single operation at an appropriate age is always preferred.

What is the Optimal Age for Operation?

There are different opinions and practices worldwide regarding the age of operation. Studies have shown that the risk of negative psychological impact on a child is high after 18 months. Performing surgery before the age of 6 months is also a deterrent due to the risks of general anesthesia. For these reasons, and considering advances in surgical techniques, while previously the 2-3 year age range was more commonly preferred, there is a growing trend to lower this limit.

In summary, the optimal age for surgery today is between 6 and 18 months.

Complications

Complications can be divided into two groups: early and late. In the early period, complications such as bleeding, suture dehiscence, and infection, which are risks in all surgeries, may occur.

In the late period, fistula (hole), stenosis (narrowing), downward curvature of the penis due to chordee recurrence, and an increased tendency towards recurrent urinary tract infections may be observed.

These complications require careful additional surgical procedures.