Hypospadias in children is a concern for many mothers who give birth to male children with this condition. Many questions are often asked by pediatric surgeons about the impact of hypospadias on the child's future health, in addition to the success rates of hypospadias repair surgery and its potential complications. In this article, Dalili Medical, we will review the most important details related to this problem and its treatment methods.

What is hypospadias?

 

Hypospadias is a congenital defect that a male fetus is born with, where the urinary opening is in an abnormal location. This defect appears during the period from the eighth to the fourteenth week of pregnancy, which is the period in which the urethra is usually formed. The shape and location of the urethral opening can vary depending on the severity of the condition, as there are different degrees of hypospadias, some of which may be mild and others may be more complex.

Is hypospadias surgery dangerous?

 

Hypospadias surgery for children is considered safe, provided that it is performed by a qualified medical team and in an appropriate medical environment.

How do I know if the hypospadias surgery was successful?

 

The success of the hypospadias surgery for children is usually linked to achieving specific medical goals, such as accurately diagnosing the child's condition, providing appropriate treatment in case of problems, and not having serious complications after the operation.

**Hypospadias and marriage**

The urethra is a tube inside the male organ (penis) that transports urine from the bladder, in addition to transporting sperm from the testicles. Therefore, the hypospadias may affect the ability to reproduce in some cases.

**Does the hypospadias affect marriage after treatment?**

 

The treatment of hypospadias depends on the type and severity of the condition (mild, moderate, or severe). In most cases, surgical treatment is used to correct the location of the urethral opening. The operation is usually performed when the child is between 3 and 8 months old, and in some severe cases, it may require a staged repair. The doctor may use skin from the genital area, so it is preferable to postpone circumcision of the child. If the operation is successful and the patient regains the natural location of the urethral opening, he can continue his life and have sex normally, while maintaining his ability to reproduce, unless there are other diseases that affect the semen.

**Does hypospadias affect marriage without treatment?**

 

Some patients can reach the stage of marriage without receiving treatment for hypospadias, as the effect of this condition on marital life and the ability to reproduce varies depending on its type. In simple cases, intercourse can take place normally and fertility is also normal, because the urethral opening is close to the head of the penis, and is not accompanied by a curvature in the body of the penis.

As for more complex cases, their effect depends on the distance of the urethral opening from the head of the penis and the degree of curvature associated with it. The case in which the urethral opening is at the scrotum is considered the most difficult, as it negatively affects both urination and intercourse, making reproduction impossible, because the semen does not reach the uterus.

**Causes and Risk Factors**

The exact cause of hypospadias is still unknown, but researchers point to several factors that may contribute to its occurrence, including:

- **Genetic factors**: Hypospadias may be more common in children whose father or sibling had the condition previously.

- **Fertility treatments**: The mother's use of hormonal treatments to increase the chances of pregnancy may have an effect.

- **Age and weight of the mother**: The child is more likely to develop hypospadias if the mother was over 35 years old during pregnancy, or if she was overweight or had diabetes.

- **Exposure to environmental factors**: The mother's exposure to harmful substances such as pesticides during pregnancy may negatively affect the development of the fetus.

- **Smoking**: Being a smoker in the mother is a contributing factor.

- **Premature birth**: Premature birth may increase the risk of hypospadias.

How does the penis work in general?

 

The main functions of the penis are to transport urine and sperm from the body. The urethra is the tube that carries urine and sperm through the penis to the outside. The urinary opening at the tip of the penis (the 'glans') facilitates these tasks.

What are the complications of not treating hypospadias in children?

 

If hypospadias in children is not treated early, they may face problems related to stopping urination normally, including:

- Fertility problems.

- Unusual spraying during urination.

- Difficulty learning to use the toilet properly.

- Abnormal curvature during erection after puberty.

- Difficulty ejaculating later after marriage.

- The appearance of deformities in the male reproductive organ, which may affect psychological health and cause feelings of helplessness or loss of self-confidence.

**Can the disease return after hypospadias surgery?**

 

One of the possible complications of hypospadias surgery is urine leakage from an opening other than the new opening, which is known as a fistula. In these cases, an additional operation may be required to close the fistula.

**Types and degrees of hypospadias**

The types and degrees of hypospadias vary depending on the location of the urethral opening. The different degrees are as follows:

- **Glanular**: The opening of the urethra is at the head of the penis, but not at the tip or tip.

- **Coronal**: This occurs when the opening of the urethra is directly under the head of the penis, where the head of the penis meets the shaft of the penis. This is the most common type.

- **Midshaft**: The opening is in the middle of the shaft of the penis towards the bottom.

- **Penoscrotal**: This occurs when the opening of the urethra is at the junction of the penis and the scrotum.- **Scrotal/Perineal**: It is considered the most severe type, where the urethral opening is on or below the scrotum.

- **Subcoronal**: In this case, the urethral opening is in an abnormal location but close to the normal location.

**Midshaft**: In this case, the urethral opening is located somewhere along the penis instead of its normal location.

**Penoscrotal**: Here, the urethral opening is located in the area where the penis meets the scrotum.

**Signs of a successful hypospadias surgery**

Hypospadias surgery is considered one of the most successful surgeries, especially when performed by experienced surgeons. Signs of a successful hypospadias surgery are as follows:

- The child's ability to urinate normally.

- The strength of the urine flow.

- The occurrence of a normal erection of the penis.

- The child does not feel any pain while urinating.

- No bacterial infections.

- Widening of the urethra.

- No twists or deformities in the penis after surgery.

What is hypospadias surgery?

 

Hypospadias surgery is a surgical procedure that aims to reconstruct and shape the hypospadias naturally, in order to achieve an aesthetic and natural function for the penis.

The procedure includes four main steps as follows:

1. Modifying the urethra.

2. Straightening and straightening the penis.

3. Restructuring or building the foreskin.

4. Placing the penile meatus at the front of the penis

This procedure is usually performed when the infant is 4 to 16 months old after birth. Before starting the procedure, the doctor anesthetizes the child to ensure that the procedure is performed safely and smoothly.

**How ​​long does hypospadias surgery take?**

 

The duration of hypospadias surgery varies from one case to another. In moderate cases, the procedure usually takes from an hour and a half to two hours. In more complex cases, the duration may extend to three hours or more.

**Diagnosis of Hypospadias**The doctor can diagnose hypospadias by noticing several clear signs on the child while examining the child's genitals. These signs include:

- The presence of the urethral opening below the head of the penis.

- The penis is bent downward.

- The appearance of what is known as the winged head, a condition that occurs during the embryonic stage as a result of the head of the penis not closing on the urethra tube.

- "Angelical purity", a colloquial term that refers to the incomplete lower part of the skin covering the head of the penis.

**Symptoms**

Hypospadias causes a group of noticeable symptoms, including:

- The presence of the urethral opening in an abnormal location at the tip of the penis.

- Abnormal urine flow during urination.

- The penis is bent or curved downward, which appears in about 15% of hypospadias cases.

- The shape of the penis appears abnormal, as the foreskin covers only the upper part of the penis.

- Undescended testicle, which means that the testicle does not descend into the scrotum, as it remains inside the body, and this condition may occur in one testicle or both testicles.

Are the symptoms of hypospadias the same in all cases?

 

Symptoms vary from one case to another depending on the degree of deformity and the location of the urethral opening.

Are urinary tract infections considered strong evidence of hypospadias?

 

Urinary tract infections can result from a group of diseases, so they are not sufficient evidence to confirm the presence of a problem in the hypospadias. However, these infections remain a generally worrying sign and require urgent medical consultation.

How long does it take to recover from hypospadias surgery in children?

 

The recovery period from hypospadias surgery in children varies based on several factors, including:

- **Type of surgery**: Recovery time depends on the type of surgery performed, as simple operations are usually faster to recover than more complex operations.

- **Severity of the urethra**: The complexity of the urethra condition may affect the recovery time, as recovery may take longer in more complicated cases.

- **Age of the child**: In general, recovery may be faster in younger children, as they are better able to tolerate surgery and recover.

- **General health of the child**: The general health of the child plays a role in the recovery time, as recovery may be slower in children with health problems or other medical conditions.

In general, the recovery time from hypospadias surgery in children can range from two to several weeks. During this period, children may need special care that includes regular medical monitoring, adequate rest, and taking prescribed medications as needed.

**Diseases associated with the hypospadias**

The penis and urethral opening of a male fetus develop between the ninth and twelfth weeks of pregnancy. Therefore, if any defect occurs in this development, other problems may appear in addition to the hypospadias, including:

1. Penile curvature: This is a physical problem in which the penis bends or tilts during erection, and its diagnosis is often delayed until after puberty. The curvature can occur in different directions, whether downward, upward, or to one side.

In all cases, the degree of curvature may affect the sexual intercourse process, as mild degrees may be unnoticeable and do not affect sexual practice.

2. Cryptorchidism: Also known as undescended testicle, this condition is represented by the failure of the testicles to descend to their natural position inside the scrotum. This problem is usually discovered during the infant's examination after birth. As for treatment, it depends on the severity of the condition. Sometimes, it is possible to wait for several years before deciding to undergo surgical intervention, as the testicle may descend naturally during the first year to a year and a half after birth. However, after this period, surgical intervention becomes necessary to maintain the condition.On the patient's ability to conceive.

** Hypospadias surgery success rate **

In general, the success rate of urethral opening repair surgeries (hypospadias) exceeds 95%. This rate depends on several factors, including:

- **Child's age**: The operation is considered more successful when performed at an early age, between 6 months and 12 months.

- **Surgeon's experience**: The surgeon's experience plays a crucial role in achieving the success of the operation.

- **Severity of the condition**: The success rate increases in simple cases.

- **Child's health**: The child must be in good health before the operation.

What happens after hypospadias surgery?

 

It is important for the mother to be aware of what will happen to her child in the days following hypospadias surgery, in order to avoid feelings of anxiety and fear, and to know what she should do and when she should consult the attending physician.

On the first day, the child may show signs of drowsiness and may refuse to eat and drink. The child's penis may also appear swollen in the first few days, but this swelling will improve within a few weeks, and will return to normal within six weeks.

The catheter should not be removed, as it is an essential part of ensuring the success of the operation. A small amount of blood in the catheter is normal, so there is no need to worry. Some slight discharge from the penis is also normal.

In some cases, the catheter may cause bladder spasms, and although it may cause the child to feel pain, it does not pose a risk to him. All that is needed is to give the child anti-bladder spasm medications.

It is also necessary to adhere to giving the child the medications prescribed by the doctor, the most important of which is antibiotics to avoid infection, which is one of the most prominent complications of the hypospadias operation, in addition to painkillers and antispasmodic medications.

When does the hypospadias operation wound heal?

 

The recovery period from hypospadias surgery is affected by several factors, including:

1. **Type of surgery**: The recovery period varies depending on the type of surgery and its complexity, as hypospadias surgeries include various procedures that affect the recovery period.

2. **Child's condition**: The child's general health condition plays a role in the speed of recovery, as recovery may be slower for children with chronic health problems or other medical conditions.

3. **Post-operative care**: Caring for the wound after the surgery is vital, including changing bandages, taking prescribed medications, and keeping the affected area clean.

4. **Doctor's instructions**: Parents must adhere to the instructions of the attending physician carefully, including wound care and following the necessary procedures.

In general, the healing of the hypospadias wound may take from two to several weeks, with this period varying depending on each child's condition. It is essential to follow the doctor's instructions and contact him in the event of any complications or persistent symptoms after the surgery.

**Stages of Hypospadias Surgery**

The pediatric surgeon can choose to perform the corrective surgery for hypospadias either in one stage or in several stages.

**Single-stage treatment**The decision is made to perform the surgery in one stage when the urethral opening is close to the head of the penis, with the possibility of correcting the penile curvature if it is present.

**Stage treatment**The child may need to undergo more than one operation to correct the hypospadias problem if the urethral opening is far from the head of the penis.

What are the possible complications of hypospadias surgery?

 

Several complications can occur after the operation, the most prominent of which are:

- Infection during the operation, which leads to swelling of the penis and the appearance of swelling at the urethral opening.

- The operation may result in permanent curvature of the penis.

- In some cases, an additional operation may be required to improve the appearance of the penis.

- Scars may form in the urethral canal or at the opening, leading to narrowing of the canal or opening, causing slow urine flow.

- In some cases, a blood clot may occur.

- A swelling may appear at the opening of the urethra due to swelling of the urethra, which may occur due to infection.

- Some cases require cosmetic surgeries to make the penis look normal or close to normal.

- Urine may leak through another opening elsewhere, which is known as a fistula.

- Narrowing of the opening of the urethra.

- Some spasms.

- Erectile dysfunction.

- Various necrosis.

- Fistula formation.

- Bleeding.

- Swelling.

**Hypoplasty | Hypoplasty**

Hypoplasty is a simple surgical procedure that is usually performed on children at an early age, between 6 and 18 months. This procedure aims to reshape the child's urethra. It is important to note that hypospadias is considered successful in most cases, as it restores the penis to its normal shape and function.

To get advice after the hypospadias surgery, you must first know the steps of the surgery, and then know what it entails. The steps of the surgery are as follows:

1. Completely anesthetize the child.

2. Make a surgical incision in the penis, then insert a urinary catheter, and make the necessary correction in the urethra.

3. Fix the urinary catheter for a period ranging from 5 to 10 days.

4. Suture the wound, taking into account the cosmetic aspect to restore the penis to its natural shape.

5. Place a bandage on the wound.

**Advice after the hypospadias surgery**

The mother must take good care of the wound and catheter, as taking care of the cleanliness of the wound is of utmost importance for the success of the hypospadias surgery. Contamination may lead to failure of the surgery and its repetition. The aspects of caring for the child at home are divided into the following:

**Catheter monitoring:** The mother may notice blood in the urine immediately after the surgery, and this is not a cause for concern. However, if the blood continues to appear later or you notice that the catheter is blocked, you should see a doctor. The catheter is usually removed after 5-10 days.

**CareBy catheterization: ** Care must be taken to follow up the catheter carefully, as it plays a major role in the success of the procedure. This can be achieved by:

- Avoiding pulling the catheter while changing the child's diaper.

- Making sure that there is no bend in the catheter, which can be noticed by leaking a small amount of urine around the catheter.

- Maintaining the catheter and preventing its blockage by encouraging the child to drink large amounts of fluids during the period of the catheter's presence, which helps avoid infections or blockage of the catheter with bladder components such as salts and stones resulting from consuming small amounts of fluids.

Instructions on how to unblock the catheter in case of blockage:

If the mother is unsure how to unblock the catheter, she should contact the doctor immediately.

It is important for parents to be alerted that:

The presence of some drops of blood during the first days after the hypospadias procedure is considered normal.

However, if there is heavy bleeding, the doctor should be consulted immediately.

**Methods to prevent complications of hypospadias surgery**

Complications of hypospadias surgery can be avoided by following the following steps

1. **Choosing the right surgeon**    Finding a surgeon who is specialized and experienced in performing hypospadias surgeries for children is one of the most important steps to ensure the success of the surgery and reduce the chances of complications.

2. **Follow-up after the surgery**    It is necessary to follow up periodically with the doctor after the surgery to ensure that there are no problems, such as urethral stricture or urine leakage.

3. **Pay attention to wound hygiene**   The surgical area should be kept clean and dressings should be changed regularly according to the doctor's instructions, which helps reduce the risk of infection.

4. **Use of prescribed medications**   You should adhere to taking the antibiotics or anti-inflammatory drugs prescribed by the doctor to ensure proper recovery and reduce the chances of infections.

5. **Awareness of danger signs** Parents should be aware of danger signs, such as fever, excessive swelling, or urine leakage from abnormal places, and go to the doctor if any of these symptoms appear.

6. **Proper nutrition** Good nutrition boosts the child's immunity and helps speed up the wound healing process better.